Paramedics working in general practice: a scoping review

David Xi,Walter Cullen,Gina Agarwal,Geoff Mccombe,Matthew Booker,Tomás Barry,Gerard Bury

doi:10.12688/hrbopenres.13250.1

Abstract

Background: The term ‘paramedic’ has traditionally related to a healthcare professional trained to provide pre-hospital emergency care; however, paramedics are increasingly taking on novel additional non-emergency roles. General practice is facing unprecedented demand for its services related to rising expectations, an aging society and increased prevalence of chronic disease. Paramedics may be recruited to work in general practice to meet some of these demands. We undertook a scoping review to map the current literature considering paramedics working in general practice and inform follow-on research. Methods: We employed the six-stage scoping review framework developed by Arksey and O’Malley. Our research question was ‘to identify the scope of practice, nature of training/qualifications, challenges faced, and impacts of paramedics working in general practice’. Results: After searching PUBMED (Medline, n = 487), EMBASE (n = 536) and the Cochrane Library (n = 0) in June 2020, we identified eleven full-text articles that met our inclusion criteria. The literature suggests that paramedics have diverse skills that enable roles within general practice, some of which are context specific. Additional training is considered necessary to facilitate the transition from emergency care to general practice. We found no research that quantitatively assessed the impact of paramedics working in general practice on healthcare expenditure or patient health outcomes. Conclusions: There is a paucity of empiric scientific literature considering paramedic working in general practice. Further research is needed to inform training pathways, the structure of clinical practice and to measure outcomes.

Highlights

Health systems are attempting to shift their focus from a specialist-centred, hospital-based approach to a primary healthcare model that emphasises integration and continuity of care[1,2]
Much of the previous literature has considered the broad concept of paramedics working in primary care or examined novel primary care interventions delivered by paramedics[5,16,23,24,25,26,27]. In this current review we aimed to focus on the published evidence in relation to paramedics undertaking roles in the setting of general practice rather than considering novel primary care or ambulance service initiatives
All but one article considered paramedics working in general practice in the United Kingdom

Summary

Introduction

Health systems are attempting to shift their focus from a specialist-centred, hospital-based approach to a primary healthcare model that emphasises integration and continuity of care[1,2]. The role of paramedics may go beyond emergency care to encompass the broader healthcare of the population and include chronic disease management[6,7,8]. Could such role expansion happen within settings other than the emergency services where they currently work?. We undertook a scoping review to map the current literature considering paramedics working in general practice and inform follow-on research. Our research question was ‘to identify the scope of practice, nature of training/qualifications, challenges faced, and impacts of paramedics working in general practice’. Further research is needed to inform training pathways, the structure of clinical practice and to measure outcomes

Objectives

Methods

Results

Conclusion