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

Abstract

Objectives The aim for this study was to provide information about how community paramedicine home visit programs best “navigate” their role delivering preventative care to frequent 9-1-1 users by describing demographic and clinical characteristics of their patients and comparing them to existing community care populations. Methods Our study used secondary data from standardized assessment instruments used in the delivery of home care, community support services, and community paramedicine home visit programs in Ontario. Identical assessment items from each instrument enabled comparisons of demographic, clinical, and social characteristics of community-dwelling older adults using descriptive statistics and z-tests. Results Data were analyzed for 29,938 home care clients, 13,782 community support services clients, and 136 community paramedicine patients. Differences were observed in proportions of individuals living alone between community paramedicine patients versus home care clients and community support clients (47.8%, 33.8%, and 59.9% respectively). We found higher proportions of community paramedicine patients with multiple chronic disease (87%, compared to 63% and 42%) and mental health-related conditions (43.4%, compared to 26.2% and 18.8% for depression, as an example). Conclusion When using existing community care populations as a reference group, it appears that patients seen in community paramedicine home visit programs are a distinct sub-group of the community-dwelling older adult population with more complex comorbidities, possibly exacerbated by mental illness and social isolation from living alone. Community paramedicine programs may serve as a sentinel support opportunity for patients whose health conditions are not being addressed through timely access to other existing care providers. Protocol registration ISRCTN 58273216.

The development of community paramedicine; a restricted review

“…relatives and carers). Sample sizes ranged from six (Proctor, 2019 ) to 43,856 (Leyenaar, McLeod, et al, 2021 ).…”

“…Similarly, Boykin et al ( 2018 ) outlined a similar model involving paramedics, pharmacists and advanced practitioners in cardiology responding to patients with heart failure. Other programmes included community paramedics working in Mental Health Crisis Response Teams (Leyenaar, McLeod, et al, 2021 ) providing care in homeless shelter programmes (Tangherlini et al, 2016 ) and working within a rapid access team alongside Family Physicians (Barrett et al, 2004 ). The need for community paramedics to have effective clinical and managerial links with other health providers was well documented (Flint, 2019 ; Mason, Knowles, et al, 2007 ; O'Meara et al, 2015 ; Rasku et al, 2019 ; Whalen et al, 2018 ).…”

“…A more recent model used community paramedics as a delegated home visit response from the heart failure specialist (Feldman et al, 2021), to expedite patient access to non-emergency treatment associated with their condition. Similarly, Boykin et al (2018) Health Crisis Response Teams (Leyenaar, McLeod, et al, 2021) providing care in homeless shelter programmes (Tangherlini et al, 2016) and working within a rapid access team alongside Family Physicians (Barrett et al, 2004). The need for community paramedics to have effective clinical and managerial links with other health providers was well documented (Flint, 2019;Mason, Knowles, et al, 2007;O'Meara et al, 2015;Rasku et al, 2019;Whalen et al, 2018).…”

Palliative care models for patients living with advanced cancer: a narrative review for the emergency department clinician

“…Community paramedicine (CP), while part of MIH, involves paramedics working to support and enrich existing programs and care plans with the goal of improving care for patients while decreasing ED visits [77]. This model of CP is still evolving, with several pilot programs working towards different aims depending on geographic location and regulatory body [78][79][80][81]. Some programs require staff, such as paramedics and/or emergency medical technicians (EMTs), to receive additional training, education, and skills to care for patients at home or in alternate destinations (e.g., primary care) [76].…”

Avoiding ED transport of elders: a need for an integrated multidisciplinary approach

“…Canada's population is aging and with such demographic changes come challenges and opportunities. In this issue of CJEM, Leyenaar and colleagues [1] explore how different paramedicine programs in Ontario offer care to elderly patients at home. In attempting to map the landscape of these varied programs, they noted differences in the community paramedicine patients and the usual homecare patients.…”