Table 2 Study, patient and role of paramedic characteristics
Author(s) Year | Country | Study Design | Patient characteristics | Role of Paramedic | Paramedic’s additional training | |
|---|---|---|---|---|---|---|
1 | Abrashkin et al. 2016 [41] Abraskhin et al. 2019 [42] | USA | Observational studies | Elderly patients, home-bound with two or more chronic condition, enrolled in the advanced illness management (AIM) program. | Assessment • In-home evaluation and treatment of acute illnesses. • Telephone triage with acuity rating code Communication • Discussion of emergency department (ED) transport or attempted home interventions with physician through video or telephone conferencing. | Additional 40 h of instruction in geriatrics and home-based primary care through didactic training and physician observation. |
2 | Agarwal et al. 2018 [43] Agarwal et al. 2019 [44] | Canada | Cluster randomized controlled trials | Residents aged 55 years and older of a subsidized apartment building. | Assessment • Assessment of cardiovascular, diabetes, and fall risk. Education • Disease prevention and health promotion sessions. Referral • Identification of high-risk patients and referral to healthcare • Targeted referral to community resources • Referral to urgent care or ED in case of emergency medical incident. Communication • Regular communication of participants’ health information with their family physician. | Community paramedics (CP) undertook online modules on chronic diseases, their risk factors, risk assessment using validated tools, and health promotion methods (approximately 4 h of training); webinars were used for CP@clinic database training (1 h of training); in-person observation using a train-the-trainer model was expected by each paramedic service for at least 1 clinic session of 2–3 h duration. |
3 | Bennett et al. 2018 [45] | USA | Pre/post-test with a comparison group study design. | Frequent users of the ED and have at least 1 chronic disease. | Assessment • Home safety assessments • General assessments: medication reconciliation, blood glucose, and weight checks • Cardiovascular and respiratory care • Post-discharge follow-up Education • Patient education Referral • Connecting participants to resources for primary care delivery • Applications for benefits • Referral to urgent care or ED in case of emergency medical incident. | 200 h didactic training & 100 h local clinic time, with at least 10 years in Paramedic Services and at least 4 years at the local county Paramedic Services. |
4 | Brydges et al. 2015 [46] | Canada | Interpretivist qualitative approach | Seniors | Referral • Initiating referrals to community services | Varied forms of education: training by continuing medical education, email communication, or none at all. |
5 | Brydges et al. 2016 [26] Agarwal et al. 2017 [47] | Canada | Brydges: Interpretivist qualitative approach Agarwal: A prospective pre-post approach for intervention study | Residents aged 55 years and older living in a subsidized housing building | Assessment • Two four-hour sessions per week. • Cardiovascular, diabetes and fall risk assessment. Education • Providing education based on risk assessment, including information on local resources. Referral • Developed individualised action plan directing participants to available community resources. • Standard protocol was followed for emergency action. Communication • Participant’s information was faxed to family physician once a month. | Half-day long training session by public health nurse and family doctor in taking blood pressure, conducting health assessment, educating residents and using the program’s database. |
6 | Dainty et al. 2018 [48] | Canada | Qualitative study | Patients living with one of three major chronic diseases: diabetes mellitus, congestive heart failure, and chronic obstructive pulmonary disease. | Assessment • Scheduled home visits at 3-month intervals and follow-up and emergency home visits to assess and treat patients. | Six-week intensive course in chronic disease management. |
7 | Jensen et al. 2014 [49] | Canada | Qualitative approach | LTC residents | Assessment • Managing acute situations in the patient’s home environment. Referral • Arranging transfers to occur at a time where the receiving department can see the patient more quickly. | Two weeks of additional training in: (1) geriatric assessments and management; (2) EOL care; (3) primary wound closure techniques (suturing, tissue adhesive); and (4) point of care testing. |
8 | Kant et al. 2018 [50] | USA | Case series / Mixed methods | Geriatric patients | Assessment • Home-based episodic care | – |
9 | Mason et al. 2008 [51] | UK | Cluster-randomized controlled trial | Patients aged 60 years or older with minor injury or illness. | Assessment • Assess and, where possible, treat patients in the community. Referral • Referral to ED, general practitioner, district nurse, or community social services. | Three-week lecture-based program to assess and (where possible) treat older people in the community, followed by 45 of supervised practice. |
10 | O’Meara et al. 2015 [27] | Canada | Observational, ethnographic research | – | – | Enhanced knowledge and broader understanding of health issues. |