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BackgroundSeniors living in subsidized housing have lower income, poorer health, and increased risk for cardiometabolic diseases and falls. Seniors also account for more than one third of calls to Emergency Medical Services (EMS). This study examines the effectiveness of the Community Health Assessment Program through EMS (CHAP-EMS) in reducing blood pressure, diabetes risk, and EMS calls.MethodsParamedics on modified duty (e.g. injured) conducted weekly, one-on-one drop-in sessions in a common area of one subsidized senior’s apartment building in Hamilton, Ontario. Paramedics assessed cardiovascular, diabetes, and fall risk, provided health education, referred participants to local resources, and encouraged participants to return to CHAP-EMS for follow-up. Reports were faxed to the family physician regularly. Blood pressure was collected throughout the one year intervention, while diabetes risk was assessed at baseline and after 6–12 months. EMS call volumes were collected from the Hamilton Paramedic Service for two years pre-intervention and one year during the intervention.ResultsThere were 79 participants (mean age = 72.2 years) and 1,365 participant visits to CHAP-EMS. The majority were female (68%), high school educated or less (53%), had a family doctor (90%), history of hypertension (58%), high waist circumference (64%), high body mass index (61%), and high stress (53%). Many had low physical activity (42%), high fat intake (33%), low fruit/vegetable intake (30%), and were current smokers (29%). At baseline, 42% of participants had elevated blood pressure. Systolic blood pressure decreased significantly by the participant’s 3rd visit to CHAP-EMS and diastolic by the 5th visit (p < .05). At baseline, 19% of participants had diabetes; 67% of those undiagnosed had a moderate or high risk based on the Canadian Diabetes Risk (CANRISK) assessment. 15% of participants dropped one CANRISK category (e.g. high to moderate) during the intervention. EMS call volume decreased 25% during the intervention compared to the previous two years.ConclusionsCHAP-EMS was associated with a reduction in emergency calls and participant blood pressure and a tendency towards lowered diabetes risk after one year of implementation within a low income subsidized housing building with a history of high EMS calls.Trial registrationRetrospectively registered on May 12th 2016 with clinicaltrials.gov: NCT02772263

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Background Frequent users of emergency medical services (EMS) comprise a disproportionate percentage of emergency department (ED) visits. EDs are becoming increasingly overwhelmed and a portion of use by frequent callers of EMS is potentially avoidable. Social factors contribute to frequent use however few studies have examined their prevalence. This study aims to describe social isolation/loneliness, poverty, and quality of life in a sample of frequent callers of EMS in the Hamilton region, a southern Ontario mid-sized Canadian city. Study design Cross-sectional quantitative study. Methods We surveyed people who called EMS five or more times within 12 months. A mailed self-administered survey with validated tools, and focused on four major measures: demographic information, social isolation, poverty, and quality of life. Results Sixty-seven frequent EMS callers revealed that 37–49% were lonely, 14% had gone hungry in the preceding month, and 43% had difficulties making ends meet at the end of the month. For quality of life, 78% had mobility problems, 55% had difficulty with self-care, 78% had difficulty with usual activities, 87% experienced pain/discomfort, and 67% had anxiety/depression. Overall quality adjusted life years value was 0.53 on a scale of 0 to 1. The response rate was 41.1%. Conclusions Loneliness in our participants was more common than Hamilton and Canadian rates. Frequent EMS callers had higher rates of poverty and food insecurity than average Ontario citizens, which may also act as a barrier to accessing preventative health services. Lower quality of life may indicate chronic illness, and users who cannot access ambulatory care services consistently may call EMS more frequently. Frequent callers of EMS had high rates of social loneliness and poverty, and low quality of life, indicating a need for health service optimization for this vulnerable population.

IntroductionChronic diseases and falls substantially contribute to morbidity/mortality among seniors, causing this population to frequently seek emergency medical care. Research suggests the paramedic role can be successfully expanded to include community-based health promotion and prevention. This study implements a community paramedicine programme targeting seniors in subsidised housing, a high-risk population and frequent users of emergency medical services (EMS). The aims are to reduce EMS calls, improve health outcomes and healthcare utilisation.Methods/analysisThis is a pragmatic clustered randomised control trial in four communities across Ontario, Canada. Within each, four to eight seniors’ apartment buildings will be paired and within each pair one building will be randomly assigned to receive the Community Health Assessment Programme through EMS (CHAP-EMS) intervention, while the other building receives no intervention. During the 1-year intervention, paramedics will run weekly sessions in a common area of the building, assessing risk factors for cardiovascular disease, diabetes and falls; providing health education and referrals to community programmes; and communicating results to the participant's primary physician. The primary outcomes are rate of emergency calls per 100 residents, change in blood pressure and change in Canadian Diabetes Risk (CANRISK) score, as collected by the local EMS and study databases. The secondary outcomes are change in health behaviours, measured using a preintervention and postintervention survey and healthcare utilisation, available through administrative databases. Analysis will mainly consist of descriptive statistics and generalised estimating equations, including subgroup cluster analysis.Ethics/disseminationThis study is approved by the Hamilton Integrated Research Ethics Board and will follow the Tri-Council Policy Statement. Findings will be disseminated through reports to local stakeholders, publication in peer-reviewed journals and conference presentations.Trial registration numberNCT02152891.

BackgroundThe increasing prevalence of type 2 diabetes mellitus (T2DM) can have a substantial impact in low- and middle-income countries (LMICs). Community-based programs addressing diet, physical activity, and health behaviors have shown significant benefits on the prevention and management of T2DM, mainly in high-income countries. However, their effects on preventing T2DM in the at-risk population of LMICs have not been thoroughly evaluated.MethodsThe Cochrane Library (CENTRAL), MEDLINE, EMBASE and two clinical trial registries were searched to identify eligible studies. We applied a 10 years limit (from 01 Jan 2008 to 06 Mar 2018) on English language literature. We included randomized controlled trials (RCTs) with programs focused on lifestyle changes such as weight loss and/or physical activity increase, without pharmacological treatments, which aimed to alter incidence of diabetes or one of the T2DM risk factors, of at least 6 months duration based on follow-up, conducted in LMICs.ResultsSix RCTs randomizing 2574 people were included. The risk of developing diabetes in the intervention groups reduced more than 40%, RR (0.57 [0.30, 1.06]), for 1921 participants (moderate quality evidence), though it was not statistically significant. Significant differences were observed in weight, body mass index, and waist circumference change in favor of community-based programs from baseline, (MD [95% CI]; − 2.30 [− 3.40, − 1.19], p < 0.01, I2 = 87%), (MD [95% CI]; − 1.27 [− 2.10, − 0.44], p < 0.01, I2 = 96%), and (MD [95% CI]; − 1.66 [− 3.17, − 0.15], p = 0.03, I2 = 95%), respectively. The pooled effect showed a significant reduction in fasting blood glucose and HbA1C measurements in favor of the intervention (MD [95% CI]; − 4.94 [− 8.33, − 1.55], p < 0.01, I2 = 62%), (MD [95% CI]; − 1.17 [− 1.51, − 0.82], p < 0.01, I2 = 46%), respectively. No significant difference was observed in 2-h blood glucose values, systolic or diastolic blood pressure change between the two groups.ConclusionBased on available literature, evidence suggests that community-based interventions may reduce the incidence rate of T2DM and may positively affect anthropometric indices and HbA1C. Due to the heterogeneity observed between trials we recommend more well-designed RCTs with longer follow-up durations be executed, to confirm whether community-based interventions lead to reduced T2DM events in the at-risk population of LMIC settings.Electronic supplementary materialThe online version of this article (10.1186/s12992-019-0451-4) contains supplementary material, which is available to authorized users.

As the population of older adults continues to grow, the appropriate resources must be available to both improve and support the health literacy level of the population. Future health research should gather information on the health literacy levels of target populations to ensure more equitable health service. This research provides a significant opportunity to better understand populations with health literacy barriers.