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Tarride JE, Stennett D, Coronado AC, Moxam RS, Yong JHE, Carter AJE, Cameron C, Xie F, Grignon M, Seow H, Blackhouse G. Economic evaluation of the "paramedics and palliative care: bringing vital services to Canadians" program compared to the status quo. CAN J EMERG MED 2024; 26:671-680. [PMID: 39083199 PMCID: PMC11377656 DOI: 10.1007/s43678-024-00738-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 06/16/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE Based on programs implemented in 2011-2013 in three Canadian provinces to improve the support paramedics provide to people receiving palliative care, the Canadian Partnership Against Cancer and Healthcare Excellence Canada provided support and funding from 2018 to 2022 to spread this approach in Canada. The study objectives were to conduct an economic evaluation of "the Program" compared to the status quo. METHODS A probabilistic decision analytic model was used to compare the expected costs, the quality-adjusted life years (QALYs) and the return on investment associated with the Program compared to the status quo from a publicly funded healthcare payer perspective. Effectiveness data and Program costs, expressed in 2022 Canadian dollars, from each jurisdiction were supplemented with literature data. Probabilistic sensitivity analyses varying key model assumptions were conducted. RESULTS Analyses of 5416 9-1-1 calls from five jurisdictions where paramedics provided support to people with palliative care needs between April 1, 2020 and March 31, 2022 indicated that 60% of the 9-1-1 calls under the Program enabled people to avoid transport to the emergency department and receive palliative care at home. Treating people at home saved paramedics an average of 31 min (range from 15 to 67). The Program was associated with cost savings of $2773 (95% confidence interval [CI] $1539-$4352) and an additional 0.00069 QALYs (95% CI 0.00024-0.00137) per 9-1-1 palliative care call. The Program return on investment was $4.6 for every $1 invested. Threshold analyses indicated that in order to be cost saving, 33% of 9-1-1 calls should be treated at home under the Program, the Program should generate a minimum of 97 calls per year with each call costing no more than $2773. CONCLUSION The Program was cost-effective in the majority of the scenarios examined. These results support the implementation of paramedic-based palliative care at home programs in Canada.
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Affiliation(s)
- J E Tarride
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada.
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
| | - D Stennett
- Healthcare Excellence Canada, Ottawa, ON, Canada
| | - A C Coronado
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - R Shaw Moxam
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - J H E Yong
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - A J E Carter
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
- Emergency Health Services Nova Scotia, Halifax, NS, Canada
- Schulich School of Medicine, Western University, London, ON, Canada
| | - C Cameron
- Canadian Virtual Hospice, Winnipeg, MB, Canada
- McNally Project for Paramedicine Research, Toronto, ON, Canada
- Department of Paramedicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - F Xie
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - M Grignon
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
- Department of Health, Aging and Society, Faculty of Social Sciences, McMaster University, Hamilton, ON, Canada
| | - H Seow
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - G Blackhouse
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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2
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Zelmer J. Getting better at getting better: Advancing quality and safety in healthcare. Healthc Manage Forum 2024:8404704241271164. [PMID: 39208022 DOI: 10.1177/08404704241271164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Scaling the innovative models of care, policies, practices, and technologies that deliver true value requires deliberate, focused effort. We need to simultaneously apply practical strategies that enable change agents to drive meaningful, sustainable impact to address particular challenges that a health system is facing, alongside implementing proven, evidence-informed approaches that broadly strengthen health system foundations. Both approaches matter; it's not about choosing between them. Rather, we need to respond to the health system's specific and immediate needs, while also growing culture, capacity, systems, and tools that enable transformation in quality and safety.
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Affiliation(s)
- Jennifer Zelmer
- Healthcare Excellence Canada, Ottawa, Ontario, Canada
- University of Victoria, Victoria, British Columbia, Canada
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3
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Batt AM, Lysko M, Bolster JL, Poirier P, Cassista D, Austin M, Cameron C, Donnelly EA, Donelon B, Dunn N, Johnston W, Lanos C, Lunn TM, Mason P, Teed S, Vacon C, Tavares W. Identifying Features of a System of Practice to Inform a Contemporary Competency Framework for Paramedics in Canada. Healthcare (Basel) 2024; 12:946. [PMID: 38727503 PMCID: PMC11083595 DOI: 10.3390/healthcare12090946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/28/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Paramedic practice is highly variable, occurs in diverse contexts, and involves the assessment and management of a range of presentations of varying acuity across the lifespan. As a result, attempts to define paramedic practice have been challenging and incomplete. This has led to inaccurate or under-representations of practice that can ultimately affect education, assessment, and the delivery of care. In this study, we outline our efforts to better identify, explore, and represent professional practice when developing a national competency framework for paramedics in Canada. METHODS We used a systems-thinking approach to identify the settings, contexts, features, and influences on paramedic practice in Canada. This approach makes use of the role and influence of system features at the microsystem, mesosystem, exosystem, macrosystem, supra-macrosystem, and chronosystem levels in ways that can provide new insights. We used methods such as rich pictures, diagramming, and systems mapping to explore relationships between these contexts and features. FINDINGS When we examine the system of practice in paramedicine, multiple layers become evident and within them we start to see details of features that ought to be considered in any future competency development work. Our exploration of the system highlights that paramedic practice considers the person receiving care, caregivers, and paramedics. It involves collaboration within co-located and dispersed teams that are composed of other health and social care professionals, public safety personnel, and others. Practice is enacted across varying geographical, cultural, social, and technical contexts and is subject to multiple levels of policy, regulatory, and legislative influence. CONCLUSION Using a systems-thinking approach, we developed a detailed systems map of paramedic practice in Canada. This map can be used to inform the initial stages of a more representative, comprehensive, and contemporary national competency framework for paramedics in Canada.
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Affiliation(s)
- Alan M. Batt
- Faculty of Health Sciences, Queen’s University, 99 University Avenue, Kingston, ON K7L 3N6, Canada
- Department of Paramedicine, Monash University, Building H, Peninsula Campus, 47–49 Moorooduc Hwy, Frankston, VIC 3199, Australia; (J.L.B.); or (C.C.); (C.L.); (T.M.L.)
| | - Meghan Lysko
- Oxford County Paramedic Services, 377 Mill Street, Woodstock, ON N4S 7V6, Canada;
| | - Jennifer L. Bolster
- Department of Paramedicine, Monash University, Building H, Peninsula Campus, 47–49 Moorooduc Hwy, Frankston, VIC 3199, Australia; (J.L.B.); or (C.C.); (C.L.); (T.M.L.)
- BC Emergency Health Services, Clinical Governance and Professional Practice, 2955 Virtual Way, Vancouver, BC V5M 4X3, Canada
| | - Pierre Poirier
- Paramedic Association of Canada, 201-4 Florence Street., Ottawa, ON K2P 0W7, Canada; (P.P.); (D.C.)
- Ottawa Paramedic Service, 2465 Don Reid Drive, Ottawa, ON K1H 1E2, Canada; (W.J.)
| | - Derek Cassista
- Paramedic Association of Canada, 201-4 Florence Street., Ottawa, ON K2P 0W7, Canada; (P.P.); (D.C.)
| | - Michael Austin
- Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, 2475 Don Reid Drive, Ottawa, ON K1H 1E2, Canada;
| | - Cheryl Cameron
- Department of Paramedicine, Monash University, Building H, Peninsula Campus, 47–49 Moorooduc Hwy, Frankston, VIC 3199, Australia; (J.L.B.); or (C.C.); (C.L.); (T.M.L.)
- Canadian Virtual Hospice, One Morley Avenue, Winnipeg, MB R3L 2P4, Canada
| | - Elizabeth A. Donnelly
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, Ontario, ON N9A 0C5, Canada;
| | - Becky Donelon
- Health Sciences Division, Justice Institute of British Columbia, 715 McBride Boulevard, New Westminster, BC V3L 5T4, Canada;
| | - Noël Dunn
- Saskatchewan Health Authority, 1350 Albert Street, Regina, SK S4R 2R7, Canada;
| | - William Johnston
- Ottawa Paramedic Service, 2465 Don Reid Drive, Ottawa, ON K1H 1E2, Canada; (W.J.)
| | - Chelsea Lanos
- Department of Paramedicine, Monash University, Building H, Peninsula Campus, 47–49 Moorooduc Hwy, Frankston, VIC 3199, Australia; (J.L.B.); or (C.C.); (C.L.); (T.M.L.)
| | - Tyne M. Lunn
- Department of Paramedicine, Monash University, Building H, Peninsula Campus, 47–49 Moorooduc Hwy, Frankston, VIC 3199, Australia; (J.L.B.); or (C.C.); (C.L.); (T.M.L.)
| | - Paige Mason
- Ottawa Paramedic Service, 2465 Don Reid Drive, Ottawa, ON K1H 1E2, Canada; (W.J.)
- School of Interdisciplinary Studies, Royal Roads University, 2005 Sooke Road, Victoria, BC V9B 5Y2, Canada
| | - Sean Teed
- School of Paramedicine, Medavie HealthEd, 50 Eileen Stubbs Avenue, Unit 154, Dartmouth, NS B3B 0M7, Canada;
| | - Charlene Vacon
- Regional Paramedic Program for Eastern Ontario, The Ottawa Hospital, 2475 Don Reid Drive, Ottawa, ON K1H 1E2, Canada;
| | - Walter Tavares
- Department of Health and Society & Wilson Centre for Health Professions Education Research, University of Toronto, 1265 Military Trail, Toronto, ON M1C1A4, Canada;
- York Region Paramedic Services, 80 Bales Drive East, East Gwillimbury, ON L0G 1V, Canada
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Austin MA. Letter to the Editor: Impact of alternative pathways from 911 calls on ED overcrowding. CAN J EMERG MED 2024; 26:134-135. [PMID: 37804478 DOI: 10.1007/s43678-023-00603-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/20/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Michael A Austin
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Regional Paramedic Program for Eastern Ontario, Ottawa, ON, Canada.
- Department of Emergency Medicine, The Ottawa Hospital, L'Hôpital d'Ottawa, Ottawa, ON, Canada.
- University of Ottawa, L'Université d'Ottawa, Ottawa, ON, Canada.
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Juhrmann ML, Butow PN, Platts CM, Simpson P, Boughey M, Clayton JM. 'It breaks a narrative of paramedics, that we're lifesavers': A qualitative study of health professionals', bereaved family members' and carers' perceptions and experiences of palliative paramedicine. Palliat Med 2023; 37:1266-1279. [PMID: 37452564 PMCID: PMC10503236 DOI: 10.1177/02692163231186451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Paramedic practice is diversifying to accommodate evolving global health trends, including community paramedicine models and growing expertise in palliative and end-of-life care. However, despite palliative care specific clinical practice guidelines and existing training, paramedics still lack the skills, confidence and clinical support to provide this type of care. AIM To elicit paramedics', palliative care doctors and nurses', general practitioners', residential aged care nurses' and bereaved families and carers' experiences, perspectives, and attitudes on the role, barriers and enablers of paramedics delivering palliative and end-of-life care in community-based settings. DESIGN A qualitative study employing reflexive thematic analysis of data collected from semi-structured online interviews was utilised. SETTING/PARTICIPANTS A purposive sample of 50 stakeholders from all Australian jurisdictions participated. RESULTS Five themes were identified: positioning the paramedic (a dichotomy between the life saver and community responder); creating an identity (the trusted clinician in a crisis), fear and threat (feeling afraid of caring for the dying), permission to care (seeking consent to take a palliative approach) and the harsh reality (navigating the role in a limiting and siloed environment). CONCLUSION Paramedics were perceived to have a revered public identity, shaped by their ability to fix a crisis. However, paramedics and other health professionals also expressed fear and vulnerability when taking a palliative approach to care. Paramedics may require consent to move beyond a culture of curative care, yet all participant groups recognised their important adjunct role to support community-based palliative care.
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Affiliation(s)
- Madeleine L Juhrmann
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- The Palliative Centre, HammondCare, Greenwich Hospital, New South Wales, Australia
| | - Phyllis N Butow
- Chris O’Brien Lifehouse, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia
| | - Cara M Platts
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Paul Simpson
- School of Paramedicine, Faculty of Health Sciences, Western Sydney University, New South Wales, Australia
| | - Mark Boughey
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia
- St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Josephine M Clayton
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- The Palliative Centre, HammondCare, Greenwich Hospital, New South Wales, Australia
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6
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Simpson J, Remawi BN, Potts K, Blackmore T, French M, Haydock K, Peters R, Hill M, Tidball OJ, Parker G, Waddington M, Preston N. Improving paramedic responses for patients dying at home: a theory of change-based approach. BMC Emerg Med 2023; 23:81. [PMID: 37532997 PMCID: PMC10394789 DOI: 10.1186/s12873-023-00848-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Paramedics are increasingly being called to attend patients dying from advanced incurable conditions. However, confidence to deal with such calls varies, with many feeling relatively unskilled in this aspect of their role. A number of interventions have been piloted to improve their skills in end-of-life care (EoLC) but without a fully specified theoretical model. Theory of Change models can provide theoretical and testable links from intervention activities to proposed long-term outcomes and indicate the areas for assessment of effectiveness. This study aimed to develop an intervention for improving paramedic EoLC for patients in the community. METHODS A Theory of Change approach was used as the overarching theoretical framework for developing an intervention to improve paramedic end-of-life skills. Nine stakeholders - including specialist community paramedics, ambulance call handlers and palliative care specialists - were recruited to five consecutive online workshops, ranging between 60 and 90 min. Each workshop had 2-3 facilitators. Over multiple workshops, stakeholders decided on the desired impact, short- and long-term outcomes, and possible interventions. During and between these workshops a Theory of Change model was created, with the components shared with stakeholders. RESULTS The stakeholders agreed the desired impact was to provide consistent, holistic, patient-centred, and effective EoLC. Four potential long-term outcomes were suggested: (1) increased use of anticipatory and regular end-of-life medications; (2) reduced end-of-life clinical and medication errors; (3) reduced unnecessary hospitalisations; (4) increased concordance between patient preferred and actual place of death. Key interventions focused on providing immediate information on what to do in such situations including: appraising the situation, developing an algorithm for a treatment plan (including whether or not to convey to hospital) and how to identify ongoing support in the community. CONCLUSIONS A Theory of Change approach was effective at identifying impact, outcomes, and the important features of an end-of-life intervention for paramedics. This study identified the need for paramedics to have immediate access to information and resources to support EoLC, which the workshop stakeholders are now seeking to develop as an intervention.
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Affiliation(s)
- Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK.
| | - Bader Nael Remawi
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YT, UK
| | - Kieran Potts
- North West Ambulance Service NHS Trust, Bolton, BL1 5DD, UK
| | - Tania Blackmore
- Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK
| | - Maddy French
- Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK
| | - Karen Haydock
- North West Ambulance Service NHS Trust, Bolton, BL1 5DD, UK
| | - Richard Peters
- North West Ambulance Service NHS Trust, Bolton, BL1 5DD, UK
| | - Michael Hill
- Heart of Kent Hospice, Preston Hall, Aylesford, Kent, ME20 7PU, UK
| | | | - Georgina Parker
- Heart of Kent Hospice, Preston Hall, Aylesford, Kent, ME20 7PU, UK
| | | | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK
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7
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Juhrmann ML, Grindrod AE, Gage CH. Emergency medical services: the next linking asset for public health approaches to palliative care? Palliat Care Soc Pract 2023; 17:26323524231163195. [PMID: 37063113 PMCID: PMC10102939 DOI: 10.1177/26323524231163195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/20/2023] [Indexed: 04/18/2023] Open
Abstract
Emergency medical services (EMS) are a unique workforce providing 24/7 emergency care across high-income countries (HICs) and low- and middle-income countries (LMICs). Although traditionally perceived as first responders to traumatic and medical emergencies, EMS scope of practice has evolved to respond to the changing needs of communities, including a growing demand for community-based palliative care. Public health provides a useful framework to conceptualise palliative and end-of-life care in community-based settings. However, countries lack public policy frameworks recognising the role EMS can play in initiating palliative approaches in the community, facilitating goals of care at end of life and transporting patients to preferred care settings. This article aims to explore the potential role of EMS in a public health palliative care approach in a critical discussion essay format by (1) discussing the utility of EMS within a public health palliative care approach, (2) identifying the current barriers preventing public health approaches to EMS palliative care provision and (3) outlining a way forward through priorities for future research, policy, education and practice. EMS facilitate equitable access, early provision, expert care and efficacious integration of community-based palliative care. However, numerous structural, cultural and practice barriers exist, appearing ubiquitous across both HICs and LMICs. A Public Health Palliative Care approach to EMS Framework highlights the opportunity for EMS to work as a linking asset to build capacity and capability to support palliative care in place; connect patients to health and community supports; integrate alternative pathways by engaging multidisciplinary teams of care; and reduce avoidable hospital admissions by facilitating home-based deaths. This article articulates a public health approach to EMS palliative and end-of-life care provision and offers a preliminary framework to illustrate the components of a potential implementation and policy strategy.
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Affiliation(s)
| | - Andrea E. Grindrod
- Public Health Palliative Care Unit, School of
Psychology and Public Health, La Trobe University, Melbourne, VIC,
Australia
| | - Caleb H. Gage
- Division of Emergency Medicine, University of
Cape Town, Cape Town, South Africa
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8
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Juhrmann ML, Anderson NE, Boughey M, McConnell DS, Bailey P, Parker LE, Noble A, Hultink AH, Butow PN, Clayton JM. Palliative paramedicine: Comparing clinical practice through guideline quality appraisal and qualitative content analysis. Palliat Med 2022; 36:1228-1241. [PMID: 35941755 DOI: 10.1177/02692163221110419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Palliative care is an emerging scope of practice for paramedicine. The COVID-19 pandemic has highlighted the opportunity for emergency settings to deliver palliative and end-of-life care to patients wishing to avoid intensive life-sustaining treatment. However, a gap remains in understanding the scope and limitations of current ambulance services' approach to palliative and end-of-life care. AIM To examine the quality and content of existing Australian palliative paramedicine guidelines with a sample of guidelines from comparable Anglo-American ambulance services. DESIGN We appraised guideline quality using the AGREE II instrument and employed a collaborative qualitative approach to analyse the content of the guidelines. DATA SOURCES Eight palliative care ambulance service clinical practice guidelines (five Australian; one New Zealand; one Canadian; one United Kingdom). RESULTS None of the guidelines were recommended by both appraisers for use based on the outcomes of all AGREE II evaluations. Scaled individual domain percentage scores varied across the guidelines: scope and purpose (8%-92%), stakeholder involvement (14%-53%), rigour of development (0%-20%), clarity of presentation (39%-92%), applicability (2%-38%) and editorial independence (0%-38%). Six themes were developed from the content analysis: (1) audience and approach; (2) communication is key; (3) assessing and managing symptoms; (4) looking beyond pharmaceuticals; (5) seeking support; and (6) care after death. CONCLUSIONS It is important that ambulance services' palliative and end-of-life care guidelines are evidence-based and fit for purpose. Future research should explore the experiences and perspectives of key palliative paramedicine stakeholders. Future guidelines should consider emerging evidence and be methodologically guided by AGREE II criteria.
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Affiliation(s)
- Madeleine L Juhrmann
- Northern Clinical School, The University of Sydney, St Leonards, NSW, Australia.,The Palliative Centre, Greenwich Hospital, HammondCare, Greenwich, NSW, Australia
| | - Natalie E Anderson
- School of Nursing, The University of Auckland, Auckland, New Zealand.,Auckland Emergency Department, Auckland District Health Board, Auckland, New Zealand
| | - Mark Boughey
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Paul Bailey
- St John Western Australia, Perth, WA, Australia
| | | | - Andrew Noble
- South Australian Ambulance Service, Adelaide, SA, Australia
| | | | - Phyllis N Butow
- School of Psychology, The University of Sydney, Camperdown, NSW, Australia
| | - Josephine M Clayton
- Northern Clinical School, The University of Sydney, St Leonards, NSW, Australia.,The Palliative Centre, Greenwich Hospital, HammondCare, Greenwich, NSW, Australia
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Tavares W, Allana A, Beaune L, Weiss D, Blanchard I. Principles to Guide the Future of Paramedicine in Canada. PREHOSP EMERG CARE 2021; 26:728-738. [PMID: 34376112 DOI: 10.1080/10903127.2021.1965680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Paramedicine in Canada has experienced significant growth in recent years, which has resulted in a misalignment between existing guiding conceptualizations and how the profession is structured and enacted in practice. As a result, well-established boundaries, directions, and priorities may be poorly aligned with existing frameworks. The objective of this study was to explore emerging and future states of paramedicine in Canada such that guiding principles could be derived. We asked: How should paramedicine be conceptualized and enacted in Canada going forward, and, what might be the necessary enablers? Methods: This study involved in-depth one-on-one semi-structured interviews with Canadian paramedicine thought leaders. We used purposive and snowball sampling strategies to identify potential participants. Interview guide questions were used to stimulate discussion about the future of paramedicine in Canada and suggestions for implementation. We used inductive qualitative content analysis as our analytical approach, informed by a constructivist and interpretivist orientation. Results: Thirty-five key informants from across Canada participated in interviews. Ten themes were identified: (1) prioritizing patients and their communities; (2) providing health care along a health and social continuum; (3) practicing within an integrated health care framework, and partnering across sectors; (4) being socially responsive; (5) enacting professional autonomy; (6) integrating the health of professionals; (7) using quality-based frameworks; (8) enacting intelligent access to and distribution of services; (9) enacting a continuous learning environment; and, (10) being evidence-informed in practice and systems. Six enablers were also identified: shift professional culture and identity, enhance knowledge, promote shared understanding of paramedicine, integrate data environments, leverage advancing technology, advance policy, regulation and legislation. Conclusions: Our results provide a conceptual framework made up of guiding principles and enablers that provide a consolidated lens to advance the paramedicine profession in Canada (and elsewhere as appropriate) while ensuring contextual and regional needs and differences can be accounted for.
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Rosa A, Dissanayake M, Carter D, Sibbald S. Community paramedicine to support palliative care. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1912690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- A. Rosa
- Faculty of Health Sciences, Western University, London, Canada
| | - M. Dissanayake
- Faculty of Health Sciences, Western University, London, Canada
| | - D. Carter
- Middlesex-London Paramedic Service, London, Canada
| | - S. Sibbald
- Faculty of Health Sciences, Western University, London, Canada
- Department of Family Medicine Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Medicine and The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Canada
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11
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Long D, Lord B. Widening the conversation: Paramedic involvement in interprofessional care. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1890976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- David Long
- School of Health and Wellbeing, University of Southern Queensland, Queensland, Australia
| | - Bill Lord
- Department of Paramedicine, Monash University, Australia
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