Indicators of paramedic service use by community dwelling older adults

Abstract

<p>Introduction: Home care clients represent a patient group that may be served through community paramedicine (CP) programs. The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale was recently validated to identify levels of risk for use of emergency care among this population. This study investigates whether frail home care clients that were identified as being at higher risk based on their DIVERT scores were more likely to use paramedic services to access the emergency department within 90 days of assessment when compared to clients that had lower DIVERT scores.</p><p>Methods: A retrospective cohort study was conducted using regularly collected administrative data. Home care assessment data were supplemented with data on emergency department (ED) visits. Arrival by ambulance was modelled to control for DIVERT scores as well as several social and demographic variables.</p><p>Results: Within the cohort, approximately 40% of individuals visited an ED within 90 days of a home care assessment and almost half of all individuals visited an ED more than once within a year. About two-thirds of clients that visited an ED in the 90 days following assessment used an ambulance for transportation. DIVERT scores were predictive of this use with highest scores indicating 4.15 times higher odds of paramedic service use (95% CI 3.60-4.78</p><p>Conclusion: DIVERT was not developed to consider means of transportation to the ED. The results indicate that it can be used to identify frail community dwelling older adults that are likely to use paramedic services to take them to the ED. Further investigation of aspects of social isolation, carer resiliency, time of use, and characteristics associated with ED discharge are warranted. Frequent ambulance use among this population suggests that collaboration between care providers may provide opportunities to prevent unnecessary ED visits by these individuals.</p>

Paramedics assessing patients with complex comorbidities in community settings: results from the CARPE study

“…Opportunity exists for further collaboration between community-based support services agencies and home care providers, community paramedicine home visit programs, and other parts of the healthcare continuum—particularly primary care providers—to improve coordination of care to medically complex community-dwelling older adults [ 3 , 10 , 39 ]. For example, a risk scale used to determine the likelihood of an ED visit in home care clients is a likely predictor for use of paramedic services for transportation to the ED [ 16 ]. Shared case-finding to identify at-risk patients could support greater coordination between hospitals, home care providers, community support services agencies and community paramedicine programs and lead to improved patient safety and reduce unnecessary ED visits and 9-1-1 utilization.…”

“…Community paramedicine home visit programs have improved access to care for frequent callers through collaboration between primary care providers and community home care and support services agencies [4][5][6][7][8][9] resulting in patients avoiding ED visits upwards of 78% of the time and higher admission rates when visits are unavoidable [10]. Frequent callers use paramedic services for reasons beyond acute medical emergencies including to address personal or social care needs (such as loneliness, food insecurity, or other deficits in quality of life), chronic conditions (such as pain, disease, or ongoing management of mental health), or functional and mobility difficulties related to advanced age [11][12][13][14][15][16]. Across Canada, expansion of community paramedicine from pilot projects to province-wide programs [17][18][19][20] has been supported by a growing evidence base [5-7, 9, 21-24].…”

“…Whether community paramedicine home visit programs represent a duplication of community-based services requires further exploration [14,25,26]. Studies have found that home care nursing visits are associated with same-day ED visits [27], that home care clients use paramedic services for transportation to the ED for such visits [16], and that paramedic referrals are associated with increased utilization of home care services [28]. If home care clients present with lower acuity levels at an ED visit and are not admitted to hospital [27], more information is needed to determine how community paramedics could better "navigate" their role in the delivery of integrated care [25,26].…”