What do community paramedics assess? An environmental scan and content analysis of patient assessment in community paramedicine

Abstract

ObjectivesPatient assessment is a fundamental feature of community paramedicine, but the absence of a recognized standard for assessment practices contributes to uncertainty about what drives care planning and treatment decisions. Our objective was to summarize the content of assessment instruments and describe the state of current practice in community paramedicine home visit programs.MethodsWe performed an environmental scan of all community paramedicine programs in Ontario, Canada, and used content analysis to describe current assessment practices in home visit programs. The International Classification on Functioning, Disability, and Health (ICF) was used to categorize and compare assessments. Each item within each assessment form was classified according to the ICF taxonomy.ResultsA total of 43 of 52 paramedic services in Ontario, Canada, participated in the environmental scan with 24 being eligible for further investigation through content analysis of intake assessment forms. Among the 24 services, 16 met inclusion criteria for content analysis. Assessment forms contained between 13 and 252 assessment items (median 116.5, IQR 134.5). Most assessments included some content from each of the domains outlined in the ICF. At the subdomain level, only assessment of impairments of the functions of the cardiovascular, hematological, immunological, and respiratory systems appeared in all assessments.ConclusionAlthough community paramedicine home visit programs may differ in design and aim, all complete multi-domain assessments as part of patient intake. If community paramedicine home visit programs share similar characteristics but assess patients differently, it is difficult to expect that the resulting referrals, care planning, treatments, or interventions will be similar.

Performance of the interRAI ED Screener for Risk-Screening in Older Adults Accessing Paramedic Services

“…In recent years, the role of paramedics in many regions has evolved to include primary care and community referral services for older adults. ( 21 ) CP programs have rapidly expanded, resulting in paramedics seeing patients in contexts other than emergency 911 calls. This research demonstrates that the interRAI ED screener may be a useful and accurate tool for risk stratification of older adults in the paramedicine context.…”

“…A variety of screening tools have been implemented and studied in the paramedicine context, including those for emergencies (e.g., stroke ( 17 ) and sepsis ( 18 ) ) and for non-emergencies (e.g., social needs screening ( 19 ) ). Within Ontario, the Paramedic Assessing Elders at Risk of Independence Loss (PERIL) ( 20 ) screening tool has been implemented in 86% of Community Assessment and Referral Programs; ( 21 ) however, the policies around how and when the tool is used vary by region. Additionally, there are several risk-stratification tools that have been studied in the ED.…”

Improving Primary Health Care for Residents Living in Assisted Living: Evidence for Practice and Policy

“…One fundamental challenge in utilizing paramedics is balancing the emergent and primary care needs of a community. Other challenges revolve around the absence of education and training standards for community paramedics (Leyenaar et al, 2019). The adoption of paramedic community model of care requires significant recruitment, training, and professional development of paramedics (Leyenaar et al, 2019).…”

“…Other challenges revolve around the absence of education and training standards for community paramedics (Leyenaar et al, 2019). The adoption of paramedic community model of care requires significant recruitment, training, and professional development of paramedics (Leyenaar et al, 2019). It is perhaps because of challenges such as these that community paramedics have not been universally used across Canada.…”

Community paramedicine: A patch, or a real system improvement?

“…3 Leyenaar et al present an environmental scan of the style/format/type of assessment conducted by homevisit type community paramedicine programs in Ontario, Canada. 4 Both conclude that better sharing (publication) of community paramedicine program information and more standardization would improve quality and equity across programs.…”