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,

The role of paramedics, including select paramedics providing primary and preventive care in homes and community settings, is evolving in health systems around the world. These developments are associated with improvements in health outcomes, improved access to services and reduced emergency department use. Building on these existing trends in paramedicine, and because social conditions contribute to illness and are strong predictors of future health service use, addressing patients' social needs should be integrated into core paramedic practice in Canada. We discuss how paramedic education, culture and governance could better enable paramedics to address the social determinants of health. Résumé Le rôle des ambulanciers paramédicaux, notamment ceux qui fournissent des soins primaires et préventifs à domicile ou en milieu communautaire, est en pleine évolution dans les systèmes de santé du monde entier. Ces changements sont associés à une amélioration des résultats cliniques, à un meilleur accès aux services et à une utilisation réduite des services d' urgence. Dans la foulée des tendances actuelles en matière de services paramédicaux-et puisque les conditions sociales influent sur l'état de santé et constituent de forts prédicteurs de l' utilisation des services de santé-il faudrait intégrer les besoins sociaux des patients dans la pratique paramédicale de base au Canada. Nous discutons de la façon dont l'éducation, la culture et la gouvernance paramédicales pourraient mieux permettre aux ambulanciparamédicaux de tenir compte des déterminants sociaux de la santé.

Objective Guidelines for a structured assessment in community paramedicine home visit programmes have not been established and evidence to inform their creation is lacking. We sought to investigate the relevance of assessment items to the practice of community paramedics according to a pre-established clarity-utility matrix. Design We designed a modified-Delphi study consisting of predetermined thresholds for achieving consensus, number of rounds of for scoring items, a defined meeting and discussion process, and a sample of participants that was purposefully representative. Setting and participants We established a panel of 26 community paramedics representing 20 municipal paramedic services in Ontario, Canada. The sample represented a majority of paramedic services within the province that were operating a community paramedicine home visit programme. Measures Drawing from a bank of standardised assessment items grouped according to domains aligned with the International Classification on Functioning, Disability, and Health taxonomy, 64 previously pilot-tested assessment items were scored according to their clarity (being free from ambiguity and easy to understand) and utility (being valued in care planning or case management activities). Assessment items covered a broad range of health, social and environmental domains. To conclude scoring rounds, assessment items that did not achieve consensus for relevance to assessment practices were discussed among participants with opportunities to modify assessment items for subsequent rounds of scoring. Results Resulting from the first round of scoring, 54 assessment items were identified as being relevant to assessment practices and 3 assessment items were removed from subsequent rounds. The remaining 7 assessment items were modified, with some parts removed from the final items that achieved consensus in the final rounds of scoring. Conclusion A broadly representative panel of community paramedics identified consensus for 61 assessment items that could be included in a structured, multidomain, assessment instrument for guiding practice in community paramedicine home visit programmes. Trail registration number NCT58273216.

Introduction: Programs that fill gaps in fractured health and social services in response to local needs can provide insight on enacting integrated care. Grassroots programs and the changing roles of paramedics within them were analyzed to explore how the health workforce, organizations and governance could support integrated care. Methods: A study was conducted following Arksey and O’Malley’s method for scoping reviews, using Valentijn’s Rainbow Model of Integrated Care as an organizing framework. Qualitative content analysis was done on clinical, professional, organizational, system, functional and normative aspects of integration. Common patterns, challenges and gaps were documented. Results: After literature search and screening, 137 documents with 108 unique programs were analysed. Paramedics bridge reactive and preventative care for a spectrum of population needs through partnerships with hospitals, social services, primary care and public health. Programs encountered challenges with role delineation, segregated organizations, regulation and tensions in professional norms. Discussion: Five concepts were identified for fostering integrated care in local systems: single point-of-entry care pathways; flexible and mobile workforce; geographically-based cross-cutting organizations; permissive regulation; and assessing system-level value. Conclusion: Integrated care may be supported by a generalist health workforce, through cross-cutting organizations that work across silos, and legislation that balances standardization with flexibility.