Table 3 Impact of the community paramedic role in the care of the elderly on patient health and the wider healthcare system
Author(s) | Study participants | Aims / Outcome Measures | Main findings/themes | |
|---|---|---|---|---|
1 | Abrashkin 2016 [41] Abrashkin 2019 [42] | Patients 2016 (n=1602) Median age: 83 years Had at least one emergency response (n=773) Used CP at least once (n=404) Used only traditional Paramedic Services (n=369) 2019 (n=1159) Average age: 86 years | • Emergency Department (ED) transport and hospitalisation rate after Community Paramedic (CP) visit. • Response time, time on scene and medications administered. • Post-visit feedback • Patient/caregiver satisfaction • Descriptive data | Healthcare system • In 78% of CP responses, individuals were evaluated, treated, and remained at home. • One or more treatments were administered in 27.6% of CP responses. • After transport to ED, hospital admission rates were significantly higher for individuals transported after a CP response than a traditional Paramedic Services’ response. • Only 1.7% of patient who received a CP visit and were not transported to ED, were subsequently seen in an ED within 24 h of response. • Transport rates were not significantly different for those with ACP or without. Patient health • Individuals seen by CP were older, have more activity of daily living (ADL) dependencies, and have a do-not-resuscitate order than those using only traditional Paramedic Services’ responses. • Both groups had high rates of advance care planning. • High acuity responses were the most common. Patient satisfaction • Patient/caregiver satisfaction was high, stating that they felt that the goals of care were accounted for and they would use CP in future medical emergency. General • CP program can provide a safe and effective option for responding to and treating frail older adults in their home, avoiding transport to ED and likely hospitalisation. |
2 | Agarwal 2018 [43] Agarwal 2019 [44] | Patients 2018 Intervention (n=455) Control (n=637) 2019 Intervention (n=2009) Control (n=2072) Both groups: Mean age of 70 yrs | • Monthly ambulance calls at the building level per 100 apartment units. • Secondary health, knowledge, behaviour outcomes (individual level), including changes in risk factors. • Changes in blood pressure (BP), lifestyle risk-factor measures, health-related quality-of-life (HRQoL), and quality-adjusted-life-years (QALYs). | Healthcare system • There were significantly less calls in the intervention buildings. Patient health • The intervention improved risk factor profiles and the health-related quality of life of the participants. • Three HRQoL domains (self-care, usual activities, pain, and discomfort) and overall QALY significantly improved among the intervention group. • The intervention participants had improved CANRISK, implying the intervention had an impact in reducing the participants’ risk of developing diabetes. • The intervention participants’ blood pressures showed a significant and sustained decrease. |
3 | Bennett 2018 [45] | Patients Intervention (n=68) Average age 57.6 yrs. Control (n=125) Average age 55.4 yrs | • Satisfaction of participants • Screening and compliance rates • Appropriate use of care • (Non-emergent) calls to Paramedic Services • Time spent on scene • Time to return to services • ED visits • Inpatient admissions • 30-day readmission rate • Costs | Healthcare system • The program was cost-effective. • Within healthcare utilisation, care was moved from ED and inpatient to outpatient and medical home-based: significantly less transports and less ED visits. Patient health • Patients experienced an improved level of care and improved outcomes. Patient satisfaction • The patients were satisfied with the service. |
4 | Brydges 2015 [46] | Paramedics (n=23) | Get a better understanding of the ways in which paramedics experience and participate in community-based referral programs | Integration • The referral program confronted the paramedic with an alternative approach to patient care which is in conflict with the traditional values and beliefs grounded in emergency response. • Participants felt that they had an inadequate knowledge base on the referral programs, due to inadequate education. • Feedback from the services following a referral, provided to the paramedics, was seen as inadequate. • Participants felt that they, the employer and sometimes even the CCAC were not held accountable by the program. • Participants saw the referral program as a way that they could step into the role of patient advocates. |
5 | Brydges 2016 [26] Agarwal 2017 [47] | Patients 2016 (n=15) Age 63–89 2017 (n=79) Mean age 72.2 yrs | Changes in: • Number of emergency Paramedic Services calls from the seniors’ residence building • Mean blood pressure of participants • Diabetes risk profile To understand the patients’ experience with the community paramedicine program. | Healthcare system • The number of emergency calls dropped by 7.1% after 6 months, and by 25% after 12 months. • The program could decrease healthcare costs. Patient health • Prevalent risk factors assessed by the CP were: high waist circumference and elevated body mass index, and stress. • Systolic and diastolic BP dropped by the 3rd and 5th CP visit respectively. • 15% of patients dropped in risk category for diabetes after 6 to 12 months. Patient satisfaction • The paramedics were seen as caring, respectful and trustful healthcare providers. The sessions were an individualised experience. • Paramedics had a dual role as both health advocates and as emergency experts. • Patient felt that it was reassuring knowing someone was taking care of them. |
6 | Dainty 2018 [48] | Patients (n=30) Age 42–95 Family members (n=10) | To understand the experiences and perspectives of patients and families involved with the Expanding Paramedicine in the Community (EPIC) | Patient health • Patients indicated they learned new health information in management of their disease. Patient satisfaction • Participants developed a unique relationship with the EPIC paramedics, which they saw as important, trusted, and essential members of their healthcare. • Paramedics were seen as exceeding their expectations and went ‘beyond the call of duty’ to take care of the patients. • EPIC recognised the patients’ and provided a safety net in times of exacerbation and was a source of health education and accountability. |
7 | Jensen 2014 [49] | Healthcare workers (n=21) | To better understand the experience of those directly and professionally involved in various aspects of the extended care paramedics (ECP). | Training • The ECPs current training was seen as inadequate. • “Soft skills” and the ability to handle difficult conversations were seen as an essential for an ECP. • ECPs saw decision making as a significant element of their role and reported longer time on the call as they discuss the situation with staff and/or family. Integration • The ECPs are able to bridge communication with the physician or family, and effective communication was seen as important to build relationships with LTC staff. End-of-Life (EOL) • There was a mixed view on how frequent people thought ECPs are involved in EOL care. • Multiple participants saw the ECP role as permitting enough flexibility to pause and determine what the best option is for an EOL patient. • Advanced care directives were seen as useful, but they can also be confusing. |
8 | Kant 2018 [50] | Patients (n=35) Mean age 87.8 Geriatric primary care team (n=10) | To understand the use and potential impact of a community paramedicine program on patient care, including understanding provider perspectives. | Healthcare system • The majority of patients could be treated at home and did not require higher levels of care • Potential reduction of unnecessary ED visits/hospitalisations, decreasing the risk of hospital acquired complications. Patient health • The program was seen as beneficial as it gave patients greater access to care and provided reassurance and relief for caregivers. Integration • Health workers felt that they were notified too late about their patients regarding acute issues or general documentation. But the CP visit notes did give them a better insight into the patients’ home and social situation. • Geriatric team members expressed concern regarding the ability of CPs to provide appropriate geriatric-focussed care. They also questioned the integration of the program with primary care and whether the patients with acute needs should contact the service or their primary care provider first. They did see the role of CP as first responder more clearly in on-call situations. • The program is unique in that it uses a nurse practitioner or physician assistant as well as a CP. |
9 | Mason 2008 [51] | Patients Intervention (n=1118) Control (n=907) | To evaluate the safety of the clinical decisions made and appropriateness of care provided by the Paramedic Practitioners working within the new service. This was measured by unplanned ED attendance within 7 days of paramedic visit. | Healthcare system • There was an overall 10.8% return visit rate at the ED within 7 days. • There were more returns visits in the intervention group, but the proportion returning with a related condition in both groups was not found significantly different. Patient health • There was also no difference in mortality at 28 days. • The paramedics in this trial are assessing and treating older people in a manner that is as safe as the standard care provided by Paramedic Services and ED. • Suboptimal care was judged by either or both ED clinician in 2.1% of the patients not admitted after their index episodes, but this was not significantly different between the groups. |
10 | O’Meara 2015 [27] | A range of participants: • paramedic service managers • paramedics • educators • physicians • nurses • other health professionals • patients • community members | Identify and describe the nature of the relationship between public engagement and the integration of CP with local health, aged care, and social services. | Engagement • The program used a range of engagement strategies to plan and implement key elements of their program. • The program developed elements of inclusiveness thorough community paramedic interactions with clients, families and carers in public and home settings. Integration • Participants recognised the important role of the program in integrating different services for patients and helping them navigate through the health, aged care and social service systems. • It was not always obvious to some participants how the CP program is integrated with the local health system. • It was noted that the longer-term sustainability of the CP program is reliant on strong integration with existing services. • The program played a variety of roles. |