What Is the Potential of Community Paramedicine to Fill Rural Health Care Gaps?

Abstract

Community paramedicine (CP) uses emergency medical services (EMS) providers to help rural communities increase access to primary care and public health services. This study examined goals, activities, and outcomes of 31 rural-serving CP programs through structured interviews of program leaders and document review. Common goals included managing chronic disease (90.3%); and reducing emergency department visits (83.9%), hospital admissions/readmissions (83.9%), and costs (83.9%). Target populations included the chronically ill (90.3%), post-hospital discharge patients (80.6%), and frequent EMS users (64.5%). Community paramedicine programs engaged in bi-directional referrals most often with primary care facilities (67.7%), hospitals (54.8%), and home health (38.7%). Programs provided assessment, testing, preventive care, and post-discharge services. Reported outcomes were promising, but few programs used rigorous evaluation methods. Rural-serving CP programs provided services to shift costs to less expensive settings and provide appropriate care where vulnerable patients live, but more evidence is needed that care is safe, effective, and economical.

The core components of Community Paramedicine – integrated care in primary care setting: a scoping review

“…The multi‐agency collaboration was described in terms of partnership, multidisciplinary, collaboration, and integrated care . Two of the articles and reports identified Community Paramedicine as a model of integrated healthcare (MIH) providing care for patients at home or in other nonurgent settings outside the hospital .…”

“…Patients were described in terms of frequent caller, discharged patient, home‐bound, senior and long‐term patient . The prevention methods of CP varied.…”

“…Community engagement was described as an assessment of local healthcare needs, bridging the gaps of community healthcare, and community response and also the gaps between primary health care and hospital emergency (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). After the risk assessment, the local healthcare needs were identified and CP provided care as a tailored programme.…”

“…The long-term patients have been frequently transported to ED which could have been an uncomfortable and unfamiliar environment, with risks of acute infection including lengthy periods waiting on the uncomfortable ambulance stretcher. Community paramedics either took care of the patient at home or transported him/her direct to receiving unit or department; avoiding waiting time in ED (11,22,27,29,30,(32)(33)(34)(35).…”

“…Patient experiences included trust, care, respect, fun, close relationships, acceptance, increased sense of security, support and empowerment (22,26,27,29,32). According one participant: 'They are like family and that is how they make everyone feel' (26).…”