Expanding Paramedicine in the Community (EPIC): study protocol for a randomized controlled trial

Abstract

BackgroundThe incidence of chronic diseases, including diabetes mellitus (DM), heart failure (HF) and chronic obstructive pulmonary disease (COPD) is on the rise. The existing health care system must evolve to meet the growing needs of patients with these chronic diseases and reduce the strain on both acute care and hospital-based health care resources. Paramedics are an allied health care resource consisting of highly-trained practitioners who are comfortable working independently and in collaboration with other resources in the out-of-hospital setting. Expanding the paramedic’s scope of practice to include community-based care may decrease the utilization of acute care and hospital-based health care resources by patients with chronic disease.Methods/DesignThis will be a pragmatic, randomized controlled trial comparing a community paramedic intervention to standard of care for patients with one of three chronic diseases. The objective of the trial is to determine whether community paramedics conducting regular home visits, including health assessments and evidence-based treatments, in partnership with primary care physicians and other community based resources, will decrease the rate of hospitalization and emergency department use for patients with DM, HF and COPD. The primary outcome measure will be the rate of hospitalization at one year. Secondary outcomes will include measures of health system utilization, overall health status, and cost-effectiveness of the intervention over the same time period. Outcome measures will be assessed using both Poisson regression and negative binomial regression analyses to assess the primary outcome.DiscussionThe results of this study will be used to inform decisions around the implementation of community paramedic programs. If successful in preventing hospitalizations, it has the ability to be scaled up to other regions, both nationally and internationally. The methods described in this paper will serve as a basis for future work related to this study.Trial registrationClinicalTrials.gov: NCT02034045. Date: 9 January 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/1745-6215-15-473) contains supplementary material, which is available to authorized users.

Home Visit‐Based Community Paramedicine and Its Potential Role in Improving Patient‐Centered Primary Care: A Grounded Theory Study and Framework

“…A full description of the EPIC model and study methods has been previously published elsewhere (Drennan et al. ). The primary study (a randomized control trial) was conducted in partnership with two paramedic services and four family health care teams and funded through a special funding allocation from the Ontario Ministry of Health and Long‐Term Care.…”

Rural paramedics’ capacity for utilising a salutogenic approach to healthcare delivery: a literature review

“…From a paramedic perspective, there is an opportunity to both be a resource for the patient and provide better utilisation of other available resources through the assessment, influence and improvement of the patient's SOC. Paramedics are often the first, and sometimes the only, point-of-care for many people experiencing unscheduled health events (37). In addition to managing emergencies, paramedics are trained to recognise the signs and symptoms of conditions and take appropriate action before the situation becomes an emergency.…”

A scoping study and qualitative assessment of care planning and case management in community paramedicine

“…Program initiated enrolment followed a case management approach designed for frequent paramedic service callers or patients deemed eligible for enrolment through other disease management programs. In total, eight community paramedicine programs described this type of enrolment; in four programs this was the only means of enrolment (31,33,34,36,37,41,45,47). Most programs included more than one means of enrolment (see Table 2).…”

“…Four programs employed a model of care similar to the ECP model (26,37,41,45) where care was available at a patient's time of need with a focus on care provision "in-place." These programs, along with two other programs (32,34) were classified as having patient initiated enrolment. Three of the four programs that identified themselves as ECP models also indicated that the service could initiate contact with identified individuals (37,41,45) while the fourth indicated that the service also actively recruited participants (26).…”