Abstract
BackgroundFrequent users of emergency medical services for issues that could be more appropriately managed through non-urgent care deplete the limited resources of the health-care system. Community paramedicine is an emerging field that extends the role of paramedics beyond the traditional emergency response. The goal of the current study is to evaluate the impact of a community paramedicine home-visit intervention with frequent users on reducing ambulance calls, hospital visits, and admissions. The study will also provide a cross-sectional description of the characteristics of frequent users of emergency medical services.Methods/designAn open-label, pragmatic, randomized controlled trial with parallel intervention and control groups will be conducted in four paramedic services in Ontario. The sample size has been calculated as 261 per group for a 25% reduction in ambulance calls. Eligible participants will be frequent callers (three or more calls in 6 months), individuals who call for at least one lift assist, or individuals referred to the program by a paramedic. Individuals will be randomly allocated to receive either the Community Paramedicine at Home (CP@home) program intervention or their usual care (control). Intervention participants will receive up to three visits from a community paramedic, who will conduct health risk assessments, provide health promotion and education, provide referrals to local resources, and fax reports back to the family physician. Data will be collected from administrative databases (e.g., paramedic services), a custom CP@home program database, participant surveys, and key informant interviews. An intention-to-treat analysis will be conducted, including descriptive statistics and multi-level modeling to find factors predictive of primary and secondary outcomes. A thematic analysis will be used to analyze the qualitative outcomes. An economic analysis will consider the cost-effectiveness of the program.DiscussionCP@home has the potential to reduce the health-care system burden significantly by targeting current frequent users of emergency medical services. By targeting this population, CP@home aims to decrease ambulance calls and emergency department visits, reducing health-care costs and improving the quality of life of a vulnerable population. If successful, CP@home will inform the development of community paramedicine policies and the expanding role of paramedics in regions across Canada.Trial RegistrationClinicalTrials.gov, NCT02835989. Registered on July 14 2016.
Highlights
Frequent users of emergency medical services for issues that could be more appropriately managed through non-urgent care deplete the limited resources of the health-care system
Community paramedicine (CP)@home will inform the development of community paramedicine policies and the expanding role of paramedics in regions across Canada
What is the difference in the number of repeat emergency medical services (EMS) calls from individuals who are frequent callers or who call for lift assist following Community Paramedicine at Home (CP@home), compared to their own baseline and compared to a control group?
Summary
Frequent users of emergency medical services for issues that could be more appropriately managed through non-urgent care deplete the limited resources of the health-care system. Frequent 911 calls for emergency medical services (EMS) deplete limited health-care resources. A common, preventable EMS call is when an older adult needs a lift assist; that is, when the individual falls and is unable to pick themselves up due to limited mobility. Other preventable calls are from individuals of all ages who repeatedly call EMS for problems that could be handled by more appropriate community and primary care resources, such as for chronic disease management [3]. Simple interventions that manage common EMS issues related to mobility or pain and reduce risks related to poor mental health, chronic disease, and falls may reduce health-care system burden and provide potential savings
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