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

Abstract

<jats:p>Introduction Australia has had a long-standing challenge in meeting rural and remote healthcare needs. Recently, new expanded paramedic roles have proven successful in addressing healthcare gaps, however, further research is needed to establish cost-effectiveness, sustainability and training. Equally, many established rural paramedics highlight primary healthcare as fundamental to their role. This study explores combining paramedics’ existing assessment scope and unique access to patients in their living environments with the introduction of a tool to measure sense of coherence, general resistance resources and social determinants of health to build patient resiliency to improve outcomes of current and future health events. Through utilising a salutogenic approach which addresses patient wellness and capacity for utilising health resources and knowledge, paramedics can provide a more holistic and patient-centred approach to care and care planning augmenting their existing clinical scope. Methods As this study aimed to establish the feasibility of paramedics undertaking a salutogenic approach to healthcare delivery, seven questions were developed focussing on areas identified as necessary components of feasibility within the paramedic paradigm. A systematic overview of literature was conducted to identify the connection between the salutogenic theory and the provision of pre-hospital care. ResultsFifty-four articles outlined the factors associated with rural living and the aspects that impact on the potential for paramedics in rural communities to undertake a salutogenic approach to healthcare delivery. Additionally, two pieces of grey literature were identified as pertinent to the research. Conclusion It is reasonable to assume that it is a feasible option for rural paramedics to utilise their current skills and unique access to patients in rural and remote settings in a salutogenic approach to healthcare delivery by undertaking assessments of patients’ sense of coherence, general resistance resources and social determinants of health. </jats:p>

Social factors in frequent callers: a description of isolation, poverty and quality of life in those calling emergency medical services frequently

“…[76] Because paramedics have unique access to patients’ living environments, a salutogenic approach may be and has shown to be a promising option for paramedic and health service provision to effectively assess and address such social factors in patient populations. [77, 78]…”

‘I Certainly Wasn't as Patient-Centred’

“…The advocacy role fulfilled by CHWs functions as a form of caregiving with implications at not only the individual but also the broader community level (Logan and Castañeda 2020;Sabo et al 2013). Moreover, as shown in the review of the literature by Cockrell et al (2019), community paramedics adopting a salutogenic approach to healthcare delivery (i.e. focusing on factors that support health, rather than the forces that cause disease) has resulted in improved health education, patient empowerment and improved access to care among remote and rural Australian populations.…”

“…There are myriad studies that examine the impacts of community-based paramedics. In particular, these studies have noted the benefits of providing additional training in public health and the social determinants of health for paramedics in addition to their emergency medical skills or utilising paramedics to conduct community outreach (Agarwal and Brydges 2018;Allana and Pinto 2021;Cockrell et al 2019;Schulman and Thomas-Henkel 2019;Schwab-Reese et al 2021). Meryl Schulman and Caitlin Thomas-Henkel (2019) particularly call for the integration of 'non-traditional' workers, including CHWs and community paramedics, to screen and assess for the impacts of the social determinants of health.…”

“…In their literature review, Krista Cockrell et al (2019) noted the benefit of paramedics operating in rural Australia addressing the social determinants of health and taking a salutogenic approach to caregiving. The studies they assessed noted that while a paramedic may not be able to change the particular determinant, they had a positive impact on motivating patients who were experiencing them.…”

Down with falls! Paramedicine scope regarding falls amongst older adults in rural and remote communities: A scoping review

“…This is especially apparent in rural areas where primary care services are lacking. 20 Community paramedicine has been implemented through using specialist paramedics to manage low acuity presentations in the community as opposed to an emergency department, using either a 'preventative/follow-up' or 'reactive' model in North America, the UK and Australia. 21 Compared with the standard paramedic, these specialised paramedics in New South Wales, Australia, have demonstrated a 2.8 times greater nontransport rate with an associated 10-to-20-min lower average case cycle time.…”