Abstract
ObjectivesThe aim for this study was to provide information about how community paramedicine home visit programs best “navigate” their role delivering preventative care to frequent 9-1-1 users by describing demographic and clinical characteristics of their patients and comparing them to existing community care populations.MethodsOur study used secondary data from standardized assessment instruments used in the delivery of home care, community support services, and community paramedicine home visit programs in Ontario. Identical assessment items from each instrument enabled comparisons of demographic, clinical, and social characteristics of community-dwelling older adults using descriptive statistics and z-tests.ResultsData were analyzed for 29,938 home care clients, 13,782 community support services clients, and 136 community paramedicine patients. Differences were observed in proportions of individuals living alone between community paramedicine patients versus home care clients and community support clients (47.8%, 33.8%, and 59.9% respectively). We found higher proportions of community paramedicine patients with multiple chronic disease (87%, compared to 63% and 42%) and mental health-related conditions (43.4%, compared to 26.2% and 18.8% for depression, as an example).ConclusionWhen using existing community care populations as a reference group, it appears that patients seen in community paramedicine home visit programs are a distinct sub-group of the community-dwelling older adult population with more complex comorbidities, possibly exacerbated by mental illness and social isolation from living alone. Community paramedicine programs may serve as a sentinel support opportunity for patients whose health conditions are not being addressed through timely access to other existing care providers.Protocol registrationISRCTN 58273216.
Highlights
Community paramedicine programs address barriers to care faced by community-dwelling older adults (≥ 65 years of age) or other vulnerable patient populations who may otherwise resort to calling an ambulance or visiting an emergency department (ED) [1,2,3,4]
Community paramedicine home visit programs have improved access to care for frequent callers through collaboration between primary care providers and community home care and support services agencies [4,5,6,7,8,9] resulting in patients avoiding ED visits upwards of 78% of the time and higher admission rates when visits are unavoidable [10]
The proportion of patients admitted to hospital in the past 90 days was not significantly different when comparing community paramedicine patients to home care clients—47.1% and 41.9% respectively—higher than the proportion observed in community support services clients, 13.6%
Summary
Community paramedicine home visit programs have improved access to care for frequent callers through collaboration between primary care providers and community home care and support services agencies [4,5,6,7,8,9] resulting in patients avoiding ED visits upwards of 78% of the time and higher admission rates when visits are unavoidable [10]. Frequent callers use paramedic services for reasons beyond acute medical emergencies including to address personal or social care needs (such as loneliness, food insecurity, or other deficits in quality of life), chronic conditions (such as pain, disease, or ongoing management of mental health), or functional and mobility difficulties related to advanced age [11,12,13,14,15,16]. If home care clients present with lower acuity levels at an ED visit and are not admitted to hospital [27], more information is needed to determine how community paramedics could
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