Journal articles: 'Community paramedicine'

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Smith-Houskamp, Beth, Barbara Balik, and Andrea Hauser. "Innovation in Action: Community Paramedicine." Nurse Leader 15, no. 1 (February 2017): 31–33. http://dx.doi.org/10.1016/j.mnl.2016.11.003.

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Paranjape, Arnika. "The future of community paramedicine." Journal of Paramedic Practice 9, no. 3 (March 2, 2017): 97. http://dx.doi.org/10.12968/jpar.2017.9.3.97.

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Bennett, Kevin J., Matt W. Yuen, and Melinda A. Merrell. "Community Paramedicine Applied in a Rural Community." Journal of Rural Health 34 (March 23, 2017): s39—s47. http://dx.doi.org/10.1111/jrh.12233.

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Chan, Joyce, Lauren E. Griffith, Andrew P. Costa, Matthew S. Leyenaar, and Gina Agarwal. "Community paramedicine: A systematic review of program descriptions and training." CJEM 21, no. 6 (March 19, 2019): 749–61. http://dx.doi.org/10.1017/cem.2019.14.

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ABSTRACTObjectivesThe aim of this study is to identify the types of community paramedicine programs and the training for each.MethodsA systematic review of MEDLINE, Embase, grey literature, and bibliographies followed a search strategy using common community paramedicine terms. All studies published in English up to January 22, 2018, were captured. Screening and extraction were completed in duplicate by two independent reviewers. The Mixed Methods Appraisal Tool (MMAT) was used to assess studies’ methodological quality (full methodology on PROSPERO: CRD42017051774).ResultsFrom 3,004 papers, there were 64 papers identified (58 unique community paramedicine programs). Of the papers with an appraisable study design (40.6%), the median MMAT score was 3 of 4 criteria met, suggesting moderate quality. Programs most often served frequent 911 callers (48.3%) and individuals at risk for emergency department admission, readmission, or hospitalization (41.4%); and 70.7% of programs were preventive home visits. Common services provided were home assessment (29.5%), medication management (39.7%), and referral and/or transport to community services (37.9%); and 77.6% of programs involved interprofessional collaboration. Community paramedicine training was described by 57% of programs and expanded upon traditional paramedicine training and emphasized technical skills. Study heterogeneity prevented meta-analysis.ConclusionCommunity paramedicine programs and training were diverse and allowed community paramedics to address a spectrum of population health and social needs. Training was poorly described. Enabling more programs to assess and report on program and training outcomes would support community paramedicine growth and the development of formalized training or education frameworks.

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Leyenaar, Matthew S., Brent McLeod, Sarah Penhearow, Ryan Strum, Madison Brydges, Eric Mercier, Audrey-Anne Brousseau, et al. "What do community paramedics assess? An environmental scan and content analysis of patient assessment in community paramedicine." CJEM 21, no. 6 (August 1, 2019): 766–75. http://dx.doi.org/10.1017/cem.2019.379.

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ABSTRACTObjectivesPatient assessment is a fundamental feature of community paramedicine, but the absence of a recognized standard for assessment practices contributes to uncertainty about what drives care planning and treatment decisions. Our objective was to summarize the content of assessment instruments and describe the state of current practice in community paramedicine home visit programs.MethodsWe performed an environmental scan of all community paramedicine programs in Ontario, Canada, and used content analysis to describe current assessment practices in home visit programs. The International Classification on Functioning, Disability, and Health (ICF) was used to categorize and compare assessments. Each item within each assessment form was classified according to the ICF taxonomy.ResultsA total of 43 of 52 paramedic services in Ontario, Canada, participated in the environmental scan with 24 being eligible for further investigation through content analysis of intake assessment forms. Among the 24 services, 16 met inclusion criteria for content analysis. Assessment forms contained between 13 and 252 assessment items (median 116.5, IQR 134.5). Most assessments included some content from each of the domains outlined in the ICF. At the subdomain level, only assessment of impairments of the functions of the cardiovascular, hematological, immunological, and respiratory systems appeared in all assessments.ConclusionAlthough community paramedicine home visit programs may differ in design and aim, all complete multi-domain assessments as part of patient intake. If community paramedicine home visit programs share similar characteristics but assess patients differently, it is difficult to expect that the resulting referrals, care planning, treatments, or interventions will be similar.

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Elden, Odd Eirik, Oddvar Uleberg, Marianne Lysne, and Hege Selnes Haugdahl. "Community paramedicine—cost–benefit analysis and safety with paramedical emergency services in rural areas: scoping review protocol." BMJ Open 10, no. 9 (September 2020): e038651. http://dx.doi.org/10.1136/bmjopen-2020-038651.

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IntroductionCommunity paramedicine models have been developed around the world in response to demographic changes, healthcare system needs and reforms. The traditional role of the paramedic has primarily been to provide emergency medical response and transportation of patients to nearby medical facilities. As a response to healthcare service gaps in underserved communities and the growing professionalisation of the workforce, the role of community paramedicine has evolved as a new model of care. A community paramedicine model in one region might address other healthcare needs than a model in another region. Various terms are also in use for community paramedicine providers, with no consensus on the definition for community paramedics, although the definition used by the International Roundtable on Community Paramedicine has been widely accepted. We aimed to examine the current knowledge and possibly identify gaps in the research/knowledge base for cost–benefit analysis and safety concerning community paramedicine in rural areas using a scoping review methodology.Methods and analysisThis scoping review will follow the methodology developed by Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. In October 2020, we will search electronic databases (MEDLINE via PubMed, CINAHL, Cochrane and Embase) and the reference lists of key studies to identify studies for inclusion. The selection process is in two steps. First, two reviewers will independently screen identified articles for title and abstracts and, second, perform a full-text review of eligible studies for inclusion. Studies focusing on community paramedicine in rural areas, which include cost–benefit analysis or safety evaluation, will be included.Ethics and disseminationThe data used are available from publicly secondary sources, therefore this study will not require ethical review. The results will be disseminated through peer-reviewed publication.

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Leyenaar, Matthew S., Ryan P. Strum, Alan M. Batt, Samir Sinha, Michael Nolan, Gina Agarwal, Walter Tavares, and Andrew P. Costa. "Examining consensus for a standardised patient assessment in community paramedicine home visits: a RAND/UCLA-modified Delphi Study." BMJ Open 9, no. 10 (October 2019): e031956. http://dx.doi.org/10.1136/bmjopen-2019-031956.

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ObjectiveCommunity paramedicine programme are often designed to address repeated and non-urgent use of paramedic services by providing patients with alternatives to the traditional ‘treat and transport’ ambulance model of care. We sought to investigate the level of consensus that could be found by a panel of experts regarding appropriate health, social and environmental domains that should be assessed in community paramedicine home visit programme.DesignWe applied the RAND/UCLA Appropriateness Method in a modified Delphi method to investigate the level of consensus on assessment domains for use in community paramedicine home visit programme.Setting and participantsWe included a multi-national panel of 17 experts on community paramedicine and in-home assessment from multiple settings (paramedicine, primary care, mental health, home and community care, geriatric care).MeasuresA list of potential assessment categories was established after a targeted literature review and confirmed by panel members. Over multiple rounds, panel members scored the appropriateness of 48 assessment domains on a Likert scale from 0 (not appropriate) to 5 (very appropriate). Scores were then reviewed at an in-person meeting and a finalised list of assessment domains was generated.ResultsAfter the preliminary round of scoring, all 48 assessment domains had scores that demonstrated consensus. Nine assessment domains (18.8%) demonstrated a wider range of rated appropriateness. No domains were found to be not appropriate. Achieving consensus about the appropriateness of assessment domains on the first round of scoring negated the need for subsequent rounds of scoring. The in-person meeting resulted in re-grouping assessment domains and adding an additional domain about urinary continence.ConclusionAn international panel of experts with knowledge about in-home assessment by community paramedics demonstrated a high level of agreement on appropriate patient assessment domains for community paramedicine home visit programme. Community paramedicine home visit programme are likely to have similar patient populations. A standardised assessment instrument may be viable in multiple settings.

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Batt, Alan M., Amber Hultink, Chelsea Lanos, Barbara Tierney, Mathieu Grenier, and Julia Heffern. "PP19 Advances in community paramedicine in response to COVID-19." Emergency Medicine Journal 39, no. 9 (August 23, 2022): e5.11. http://dx.doi.org/10.1136/emermed-2022-999.19.

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BackgroundAlready well situated in the community, paramedics work collaboratively with other community partners to ensure patients receive the services that they require and the high quality in-home and in-community care they deserve. The ongoing COVID-19 pandemic has highlighted the prevalence of social inequities in Canada, particularly in already marginalized groups, and the importance of social connectedness and caregiver wellbeing solutions. We sought to explore innovations in community paramedicine programs across Canada in response to COVID-19.MethodsWe conducted a scoping literature review of community paramedicine publications since 2020, with a focus on Canadian context, and undertook semi-structured interviews with key informants to capture innovations that may not be well represented in the literature.ResultsA total of 22 studies, combined with 26 grey literature sources were identified through the literature search. We interviewed ten stakeholders from diverse community care and community paramedicine settings across Canada to further explore each element of the conceptual framework. A conceptual framework (Figure 1) was developed to categorize the literature and findings into themes, namely: leveraging technology (e.g., virtual consultations, remote monitoring); responding to COVID-19 (e.g., mass testing and vaccination); addressing social needs (e.g., home visits, helping patients with groceries); caring for vulnerable populations (e.g., providing palliative care at home). These innovations were united in the idea of collaborating with other health care professionals and agencies, while facilitating care and case management coordination.ConclusionsThe COVID-19 pandemic has highlighted the essential collaborative care role community paramedicine programs can provide to patients in their homes or communities. Community paramedicine programs have evolved to meet the needs of their communities. These programs have demonstrated their ability to support public health measures, provide home and community-based care, and most importantly, collaborate with other health care professionals in coordinating and providing care to Canadians regardless of social circumstances.

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Elden, Odd Eirik, Oddvar Uleberg, Marianne Lysne, and Hege Selnes Haugdahl. "Community paramedicine: cost–benefit analysis and safety evaluation in paramedical emergency services in rural areas – a scoping review." BMJ Open 12, no. 6 (June 2022): e057752. http://dx.doi.org/10.1136/bmjopen-2021-057752.

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ObjectiveTo examine the current knowledge and possibly identify gaps in the knowledge base for cost–benefit analysis and safety concerning community paramedicine in rural areas.DesignScoping review.Data sourcesMEDLINE via PubMed, CINAHL, Cochrane and Embase up to December 2020.Study selectionAll English studies involving community paramedicine in rural areas, which include cost–benefit analysis or safety evaluation.Data extractionThis scoping review follows the methodology developed by Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We systematically searched for all types of studies in the databases and the reference lists of key studies to identify studies for inclusion. The selection process was in two steps. First, two reviewers independently screened 2309 identified articles for title and abstracts and second performed a full-text review of 24 eligible studies for inclusion.ResultsThree articles met the inclusion criteria concerning cost–benefit analysis, two from Canada and one from USA. No articles met the inclusion criteria for safety evaluation.ConclusionThere are knowledge gaps concerning safety evaluation of community paramedicine in rural areas. Three articles were included in this scoping review concerning cost–benefit analysis, two of them showing positive cost-effectiveness with community paramedicine in rural areas.

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Iezzoni, Lisa I., Stephen C. Dorner, and Toyin Ajayi. "Community Paramedicine — Addressing Questions as Programs Expand." New England Journal of Medicine 374, no. 12 (March 24, 2016): 1107–9. http://dx.doi.org/10.1056/nejmp1516100.

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Crockett, Baely M., Karalea D. Jasiak, Todd A. Walroth, Kerri E. Degenkolb, Andrew C. Stevens, and Carolyn M. Jung. "Pharmacist Involvement in a Community Paramedicine Team." Journal of Pharmacy Practice 30, no. 2 (July 8, 2016): 223–28. http://dx.doi.org/10.1177/0897190016631893.

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Background: Hospital readmissions have recently gained scrutiny by health systems as a result of their high costs of care and potential for financial penalty in hospital reimbursement. Mobile-integrated health and community paramedicine (MIH-CP) programs have expanded to serve patients at high risk of hospital readmission. Pharmacists have also improved clinical outcomes for patients during in-home visits. However, pharmacists working with a MIH-CP program have not been previously described. This project utilized a novel multidisciplinary Community Paramedicine Team (CPT) consisting of a pharmacist, paramedic, and social worker to target patients with heart failure at high risk of readmission to assist with coordination of care and education. Objectives: This article describes the development of the CPT, delineation of CPT member responsibilities, and outcomes from pilot visits. Methods: The CPT visited eligible patients in their homes to provide services. Patients with heart failure who were readmitted within 30 days were eligible for a home visit. Results: A total of 6 patients were seen during the pilot, and 2 additional patients were seen after the pilot. Conclusion: Imbedding a pharmacist into a CPT provides a unique expansion of pharmacy services and a novel approach to address hospital readmissions.

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Guo, Bing, Paula Corabian, and Charles Yan. "PP159 Is Community Paramedicine A Safe/Effective Alternative To Usual Care?" International Journal of Technology Assessment in Health Care 35, S1 (2019): 67. http://dx.doi.org/10.1017/s0266462319002629.

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IntroductionDue to an aging population, shortage of healthcare staff, and escalating healthcare costs, there has been a recent shift in the professional roles and responsibilities in acute care settings to help bridge the care gap. Paramedics, whose primary responsibilities have been in emergency/transportation services, are increasingly involved in the management of chronic diseases in the community setting. However, even with additional training, there are concerns about the safety and effectiveness of this expanded role. The objective of this presentation is to highlight some of the key findings from a health technology assessment report on the safety and effectiveness of community paramedicine in assessing and managing conditions/diseases with low acuity.MethodsA systematic review was conducted to identify studies that evaluated the safety and effectiveness of different community paramedicine programs.ResultsFour systematic reviews and 20 primary studies (one randomized controlled trial (RCT) and 19 observational studies) were identified. Of these, two systematic reviews and 14 primary studies focused on the safety and effectiveness of Emergency Care Practitioner (ECP) programs ̶ widely implemented programs whereby a paramedic or nurse undertakes activities traditionally performed by physicians, such as the initial assessment of patients, provision of simple treatment, or referral of patients to other clinical care. Limited evidence showed that ECP programs are promising in reducing repeated emergency calls, emergency department visits, hospital admissions/readmissions, and emergency transport charges. While the majority of included studies did not report any safety outcomes, no significant safety issues were identified from the cluster RCT. Evidence for other types of community paramedicine is limited.ConclusionsEvaluation of the impact of community paramedicine programs remains methodologically challenging. Additional cluster RCTs may help determine the effectiveness of community paramedicine programs; safety outcomes should be a key element of future observational studies.

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Fani, Shamsi, Lizette Munoz, Susana Lavayen, Blair McKenzie, Audrey Chun, Jeff Cao, and Stephanie Chow. "Decreasing Emergency Room Utilization in High Risk Geriatric Patients." Innovation in Aging 4, Supplement_1 (December 1, 2020): 135. http://dx.doi.org/10.1093/geroni/igaa057.443.

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Abstract Background: The Acute Life Interventions Goals & Needs Program (ALIGN) at the Mount Sinai Hospital in New York City aims to work closely with high risk geriatric patients for short term intensive management of acute medical and social issues. Quantitative measures for determining success of the program is comparing emergency room visits and hospitalizations prior to and after enrollment with ALIGN. The Community Paramedicine service allows a paramedic, the ALIGN provider, and an emergency room physician to assess and triage patients in their home via video conference thereby avoiding ED visits for non-urgent services. Method: We reviewed the utilization of the Community Paramedicine service (from July 2017-February 2020) and its impact on ALIGN’s efforts to reduce unnecessary ED visits and hospitalizations. Results: 36 patients were evaluated with the Community Paramedicine service (from July 2017-February 2020). 19 or 52.8% avoided an ED visit and 17 or 47.2% were transported to the ED. 12 or 70.6% were admitted to the hospital of those that were transported to the ED initially. Top reasons for transport to ED included generalized weakness, acute mental status change (AMS), and shortness of breath (SOB). Conclusions: A Community Paramedicine program utilized by a high risk geriatrics team like ALIGN is effective in reducing ED visits and hospitalizations for the elderly population who incur greater expenses to the health care system and traditionally have poorer health outcomes.

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Goodman, Michele, and Scott A. Kasper. "Developing a Cancer Care and Community Paramedicine Partnership." Oncology Issues 37, no. 3 (May 4, 2022): 28–34. http://dx.doi.org/10.1080/10463356.2022.2055426.

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Hughes, Stephen, and Christopher Seenan. "Community paramedicine home visits: patient perceptions and experiences." Journal of Paramedic Practice 13, no. 6 (June 2, 2021): 248–57. http://dx.doi.org/10.12968/jpar.2021.13.6.248.

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Background: Community paramedicine (CP) is an emerging model of community-based healthcare delivered around the world by paramedics with additional skills, education and training. There is a lack of qualitative research on patient perceptions and experiences of this phenomenon. Aims: The study aimed to explore patient perceptions and experiences of CP home visits delivered by specialist paramedics (SPs) in a Scottish urban general practice home-visit setting. Patient acceptance and CP primary-care strategic value were examined. Methods: An explorative qualitative study using purposive sampling, semi-structured interviews and thematic analysis. Findings: Five main themes were identified: provide a well-communicated, professional, knowledgeable and comprehensive home visit consultation; SP-patient relationship and continuity of care; acceptance of SP home visits in place of GP home visits; quicker response and an increased possibility of a home visit; and limitations of the SP role. Conclusion: Patient perceptions and experience of CP were positive, with patients accepting this model of care. Opportunities to improve healthcare, including better continuity or care and health monitoring, were found.

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Yan, Charles, Bing Guo, and Paula Corabian. "PP97 Delineating Key Components Of Community Paramedicine Programs." International Journal of Technology Assessment in Health Care 34, S1 (2018): 102–3. http://dx.doi.org/10.1017/s0266462318002416.

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Introduction:Population growth, epidemiological and demographic transition, and a shortage of healthcare workers are affecting health care systems in Australia, Canada, the United Kingdom (UK), and the United States (US). Community paramedicine (CP) programs provide a bridge between primary care and emergency care to address the needs of patients with low acuity but lack of access to primary care. However, how to capture the key characteristics of these programs and present them in a meaningful way is still a challenge. The objective of this presentation is to identify and describe the characteristics of currently existing CP programs in the four countries to inform policy-making on CP program development in Alberta.Methods:Information was obtained from systematic reviews, health technology assessments, general reviews, and government documents identified through a comprehensive literature search. The characteristics of the CP programs are described using a framework originally developed in Australia with three categories: (i) the primary health care model, (ii) the health integration model (in Australia, called the substitution model), and (iii) the community coordination model.Results:In general, Australia emphasizes rural/remote paramedics, whereas Canada, the UK, and the US implement expanded paramedic practice within different environments including rural, remote, regional, and metropolitan settings. Extended care provider programs have been intensively investigated and widely implemented in the UK. While the identified CP programs vary in terms of program components, designation of providers, skill mix, target population, and funding model, the majority of these CP programs fall under the primary health care category of the Australian framework.Conclusions:Transitioning from hospital-based to community-based health care requires careful consideration of all key factors that could contribute to future program success. Delineating key components of CP programs using the Australian framework will help Alberta decision-makers design, develop, and implement appropriate CP programs that adequately address local needs.

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Nolan, Michael J., Katherine E. Nolan, and Samir K. Sinha. "Community paramedicine is growing in impact and potential." Canadian Medical Association Journal 190, no. 21 (May 27, 2018): E636—E637. http://dx.doi.org/10.1503/cmaj.180642.

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Reinhartz, Victoria, Shelly Kearns, Matthew Haas, Shelby Landau, and Tayanna Richardson. "Impact of community paramedicine program on APPE student skillsets." Currents in Pharmacy Teaching and Learning 13, no. 6 (June 2021): 729–35. http://dx.doi.org/10.1016/j.cptl.2021.01.037.

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Cameron, Peter, and Alix Carter. "Community paramedicine: A patch, or a real system improvement?" CJEM 21, no. 6 (November 2019): 691–93. http://dx.doi.org/10.1017/cem.2019.439.

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Georgiev, Rachel, Benoit Stryckman, and Roseann Velez. "The Integral Role of Nurse Practitioners in Community Paramedicine." Journal for Nurse Practitioners 15, no. 10 (November 2019): 725–31. http://dx.doi.org/10.1016/j.nurpra.2019.07.019.

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Quatman, Carmen, Melinda Gabriel, David Wisner, Mark Weade, Jennifer Garvin, Elizabeth Sheridan, Jessica Wiseman, and Catherine Quatman-Yates. "4428 Harnessing Community Paramedicine for Transformative Fall Prevention Solutions." Journal of Clinical and Translational Science 4, s1 (June 2020): 86. http://dx.doi.org/10.1017/cts.2020.271.

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OBJECTIVES/GOALS: Healthcare costs for falls are expected to reach nearly 55 billion dollars annually in the US by 2020. Leveraging 911 calls as trigger events to activate fall prevention solutions could transform our ability to identify high-risk individuals and significantly improve fall prevention strategies globally. METHODS/STUDY POPULATION: An innovative pilot program entitled Community-centered Fall Intervention Team (Community FIT). Community FIT that leverages 911 calls, implementation science approaches, community partnerships, and collaboration among multiple healthcare disciplines including physical therapists, community paramedics, physicians, and social service coordinators was used to design and implement a community paramedicine fall intervention program. 911 call reports from February 2016 – August 2019 were analyzed using time series analyses to measure community level outcomes in fall-related calls and transports. RESULTS/ANTICIPATED RESULTS: 224 grab bars were installed free of charge to local residents (averaging approximately $125 per home for modifications).Over an 18-month period, time series analysis indicated an approximate demonstrated a consistent drop in the average fall-related 911 calls per month from 11.6 to 4.5 calls (a change of 61.21%) and a decrease of 58% in the transport rates to the hospital for fall-related 911 calls. 911 referrals to the community paramedicine program have also increased by 83%, demonstrating increased activation of fall prevention strategies with Community FIT. DISCUSSION/SIGNIFICANCE OF IMPACT: Collectively, these pilot study results provide preliminary support for individual and system level improvements in fall prevention by leveraging 911 calls to activate a community medicine fall prevention program. Future studies are needed to determine reach, long-term effectiveness, and sustainability of the program. CONFLICT OF INTEREST DESCRIPTION: Johnson & Johnson Hip Fracture Advisory Board (not related to project submission)

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Glenn, Melody, Olivia Zoph, Kim Weidenaar, Leila Barraza, Warren Greco, Kylie Jenkins, Pooja Paode, and Jonathan Fisher. "State Regulation of Community Paramedicine Programs: A National Analysis." Prehospital Emergency Care 22, no. 2 (October 12, 2017): 244–51. http://dx.doi.org/10.1080/10903127.2017.1371260.

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Sebach, Aaron M. "Community Paramedicine Clinical Experience for Family Nurse Practitioner Students." Journal of Nursing Education 61, no. 12 (December 2022): 724. http://dx.doi.org/10.3928/01484834-20221003-09.

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Moya, Iván A., and Rebecca Connolly. "Pride in paramedicine: being an LGBTQ+ paramedic." Journal of Paramedic Practice 13, no. 7 (July 2, 2021): 300–301. http://dx.doi.org/10.12968/jpar.2021.13.7.300.

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As Pride celebrations kick off worldwide and the current issue of the Journal of Paramedic Press is sent to the printers on 28 June—the very date in history that the first Pride March was held in New York City in 1970—it seems fitting to celebrate Pride in paramedicine and hear from some paramedics in the LGBTQ+ community

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Leggio, William. "Objectives, taxonomies and competencies of community oriented and community based education applied to community paramedicine." Journal of Contemporary Medical Education 2, no. 3 (2014): 192. http://dx.doi.org/10.5455/jcme.20140716062857.

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Sawyer, Nick, and John Coburn. "Community Paramedicine: 911 Alternative Destinations Are a Patient Safety Issue." Western Journal of Emergency Medicine 18, no. 2 (February 1, 2017): 219–21. http://dx.doi.org/10.5811/westjem.2016.11.32758.

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Martin, Angela, Peter O'Meara, and Jane Farmer. "Consumer perspectives of a community paramedicine program in rural Ontario." Australian Journal of Rural Health 24, no. 4 (December 21, 2015): 278–83. http://dx.doi.org/10.1111/ajr.12259.

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Chellappa, Deepa K., Linda V. DeCherrie, Christian Escobar, Diana Gregoriou, and Kevin G. Munjal. "Supporting the on-call primary care physician with community paramedicine." Internal Medicine Journal 48, no. 10 (October 2018): 1261–64. http://dx.doi.org/10.1111/imj.14049.

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Raynovich, William, Michael Weber, Michael Wilcox, Gary Wingrove, Anne Robinson-Montera, and Susan Long. "A survey of community paramedicine course offerings and planned offerings." International Paramedic Practice 4, no. 1 (May 21, 2014): 19–24. http://dx.doi.org/10.12968/ippr.2014.4.1.19.

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Agarwal, Gina, Melissa Pirrie, Ricardo Angeles, Francine Marzanek, Lehana Thabane, and Daria O'Reilly. "Cost-effectiveness analysis of a community paramedicine programme for low-income seniors living in subsidised housing: the community paramedicine at clinic programme (CP@clinic)." BMJ Open 10, no. 10 (October 2020): e037386. http://dx.doi.org/10.1136/bmjopen-2020-037386.

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ObjectivesTo evaluate the cost-effectiveness of the Community Paramedicine at Clinic (CP@clinic) programme compared with usual care in seniors residing in subsidised housing.DesignA cost–utility analysis was conducted within a large pragmatic cluster randomised controlled trial (RCT). Subsidised housing buildings were matched by sociodemographics and location (rural/urban), and allocated to intervention (CP@clinic for 1 year) or control (usual care) via computer-assisted paired randomisation.SettingThirty-two subsidised seniors’ housing buildings in Ontario.ParticipantsBuilding residents 55 years and older.InterventionCP@clinic is a weekly community paramedic-led, chronic disease prevention and health promotion programme in the building common areas. CP@clinic is free to residents and includes risk assessments, referrals to resources, and reports back to family physicians.Outcome measuresQuality-adjusted life years (QALYs) gained, measured with EQ-5D-3L. QALYs were estimated using area-under-the curve over the 1-year intervention, controlling for preintervention utility scores and building pairings. Programme cost data were collected before and during implementation. Costs associated with emergency medical services (EMS) use were estimated. An incremental cost effectiveness ratio (ICER) based on incremental costs and health outcomes between groups was calculated. Probabilistic sensitivity analysis using bootstrapping was performed.ResultsThe RCT included 1461 residents; 146 and 125 seniors completed the EQ-5D-3L in intervention and control buildings, respectively. There was a significant adjusted mean QALY gain of 0.03 (95% CI 0.01 to 0.05) for the intervention group. Total programme cost for implementing in five communities was $C128 462 and the reduction in EMS calls avoided an estimated $C256 583. The ICER was $C2933/QALY (bootstrapped mean ICER with Fieller’s 95% CI was $4850 ($2246 to $12 396)) but could be even more cost effective after accounting for the EMS call reduction.ConclusionThe CP@clinic ICER was well below the commonly used Canadian cost–utility threshold of $C50 000. CP@clinic scale-up across subsidised housing is feasible and could result in better health-related quality-of-life and reduced EMS use in low-income seniors.Trial registration numberClinicaltrials.gov, NCT02152891.

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Leyenaar, Matthew S., Amir Allana, Samir K. Sinha, Michael Nolan, Gina Agarwal, Walter Tavares, and Andrew P. Costa. "Relevance of assessment items in community paramedicine home visit programmes: results of a modified Delphi study." BMJ Open 11, no. 11 (November 2021): e048504. http://dx.doi.org/10.1136/bmjopen-2020-048504.

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Objective Guidelines for a structured assessment in community paramedicine home visit programmes have not been established and evidence to inform their creation is lacking. We sought to investigate the relevance of assessment items to the practice of community paramedics according to a pre-established clarity-utility matrix. Design We designed a modified-Delphi study consisting of predetermined thresholds for achieving consensus, number of rounds of for scoring items, a defined meeting and discussion process, and a sample of participants that was purposefully representative. Setting and participants We established a panel of 26 community paramedics representing 20 municipal paramedic services in Ontario, Canada. The sample represented a majority of paramedic services within the province that were operating a community paramedicine home visit programme. Measures Drawing from a bank of standardised assessment items grouped according to domains aligned with the International Classification on Functioning, Disability, and Health taxonomy, 64 previously pilot-tested assessment items were scored according to their clarity (being free from ambiguity and easy to understand) and utility (being valued in care planning or case management activities). Assessment items covered a broad range of health, social and environmental domains. To conclude scoring rounds, assessment items that did not achieve consensus for relevance to assessment practices were discussed among participants with opportunities to modify assessment items for subsequent rounds of scoring. Results Resulting from the first round of scoring, 54 assessment items were identified as being relevant to assessment practices and 3 assessment items were removed from subsequent rounds. The remaining 7 assessment items were modified, with some parts removed from the final items that achieved consensus in the final rounds of scoring. Conclusion A broadly representative panel of community paramedics identified consensus for 61 assessment items that could be included in a structured, multidomain, assessment instrument for guiding practice in community paramedicine home visit programmes. Trail registration number NCT58273216.

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Agarwal, Gina, Amelia Keenan, Melissa Pirrie, and Francine Marzanek-Lefebvre. "Integrating community paramedicine with primary health care: a qualitative study of community paramedic views." CMAJ Open 10, no. 2 (April 2022): E331—E337. http://dx.doi.org/10.9778/cmajo.20210179.

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Sinha, S., and N. Foster. "INSIGHTS GAINED FROM THE DEVELOPMENT OF COMMUNITY PARAMEDICINE PROGRAMS IN CANADA." Innovation in Aging 1, suppl_1 (June 30, 2017): 49. http://dx.doi.org/10.1093/geroni/igx004.199.

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Sinha, S., M. Nolan, and N. Foster. "FIRST-YEAR OUTCOMES OF THE MOHLTC-FUNDED COMMUNITY PARAMEDICINE DEMONSTRATION PROJECTS." Innovation in Aging 1, suppl_1 (June 30, 2017): 49. http://dx.doi.org/10.1093/geroni/igx004.200.

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Sinha, S., A. Thurston, J. Klich, and N. Foster. "ESTABLISHING THE EFFECTIVENESS OF THE INDEPENDENCE AT HOME COMMUNITY PARAMEDICINE MODEL." Innovation in Aging 1, suppl_1 (June 30, 2017): 49. http://dx.doi.org/10.1093/geroni/igx004.201.

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Huang, Yuan-Han, Linlin Ma, Luke A. Sabljak, and Zachary A. Puhala. "Development of sustainable community paramedicine programmes: a case study in Pennsylvania." Emergency Medicine Journal 35, no. 6 (April 17, 2018): 372–78. http://dx.doi.org/10.1136/emermed-2017-207211.

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BackgroundCommunity paramedicine (CP) models have been applied across rural and urban communities in support of healthcare delivery systems for nearly two decades. However, there is still insufficient information regarding the development of sustainable CP programmes. This study explores the strategies used by active CP programmes and investigates their operational statuses, community demographics, financial models and challenges for programme development.MethodsA series of interviews was conducted with four CP programmes in Pennsylvania, USA, which are affiliated with a local government, a health system, an ambulance service and an emergency medical service, respectively. Each CP programme uses its own model with unique goals, as well as providing corresponding services/care based on the demands from their communities.ResultsThree CP programmes in the study were mainly aimed at reducing healthcare resource utilisation (ie, reduce readmissions or ED utilisation), but one of the programmes developed a sustainable model aiding newborn care in the community. Establishing a solid reimbursement mechanism and working closely with collaborators are two major strategies for developing sustainable CP programmes. Complete data collection and a programme evaluation process will also be important to demonstrate the value of its CP models to potential collaborators and policy-makers. However, the cost-effectiveness of a CP model is still not easy to identify due to the separate programmes being developed without uniform goals.ConclusionThe challenges and solutions from the four programmes under study can provide a road map for the development of CP programmes for other communities.

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Wilcoxson, Wendy J. "Community Paramedicine and Mobile Integrated Health Care: Existing Resources Bringing New Benefits." Southern Medical Journal 109, no. 3 (March 2016): 151–53. http://dx.doi.org/10.14423/smj.0000000000000424.

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Neiman, Gregory S., and Attila J. Hertelendy. "Regulatory impediments to the implementation of a community paramedicine programme in Virginia." Journal of Paramedic Practice 8, no. 9 (September 2, 2016): 458–62. http://dx.doi.org/10.12968/jpar.2016.8.9.458.

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Adio, Oluwakemi Aiyedun, Laura H. Ikuma, Sarah Dunn, and Isabelina Nahmens. "Community Paramedics' Perception of Frequent ED Users and the Community Paramedicine Program: A Mixed-Methods Study." Journal of Health Care for the Poor and Underserved 31, no. 3 (2020): 1134–51. http://dx.doi.org/10.1353/hpu.2020.0086.

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Aiello, Stephen, Claudio Aguayo, Norm Wilkinson, and Kevin Govender. "Developing culturally responsive practice using mixed reality (XR) simulation in Paramedicine Education." Pacific Journal of Technology Enhanced Learning 3, no. 1 (February 16, 2021): 15–16. http://dx.doi.org/10.24135/pjtel.v3i1.89.

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The department of Paramedicine at Auckland University of Technology is committed to establishing informed evidence and strategies representative of all ethnicities. The MESH360 team propose that immersive mixed reality (XR) can be employed within the learning environment to introduce critical elements of patient care through authentic environmental and socio-cultural influences without putting either students, educators, practitioners or patients at risk. Clinical simulation is a technique that replicates real-world scenarios in a controlled and non-threatening environment. However, despite the legal and moral obligations that paramedics have to provide culturally competent care, a lack of evidence and guidelines exist regarding how to adequately integrate simulation methods for cultural competence training into paramedicine education. In our curriculum, clinical simulation has been used mainly to teach the biomedical aspects of care with less focus on the psychological, cultural, and environmental contexts. A potential, therefore, exists for high-fidelity clinical simulation and XR as an effective teaching strategy for cultural competence training by providing learners with the opportunity to engage and provide care for patients from different cultural backgrounds, ethnic heritages, gender roles, and religious beliefs (Roberts et al., 2014). This is crucial preparation for the realities of professional practice where they are required to care for patients that represent the entirety of their community. This presentation explores the MESH360 project and the development of a theoretical framework to inform the design of critical thinking in enhanced culturally diverse simulation clinical scenarios (ResearchGate, n.d.). The project aims to develop a transferable methodology to triangulate participant subjective feedback upon learning in high stress environments within a wide range of cultural-responsive environments. The implications for practice and/or policy are the redefinition of the role of simulation in clinical health care education to support deeper critical learning and paramedic competency within cross-cultural environments within XR. The aim of the research is to develop simulation based real-world scenarios to teach cultural competence in the New Zealand paramedicine curriculum. Using a Design-Based Research framework in healthcare education the project explores the impact of culturally-responsive XR enhanced simulation for paramedicine students through the triangulation of participant subjective feedback, observation, and participant biometric data (heart rate) (Cochrane et al., 2017). Data analysis will be structured around the identification and description of the overarching elements constituting the cultural activity system in the study, in the context of XR in paramedicine education (Engeström, 1987). Our research objective focuses upon using XR to enable new pedagogies that redefine the role of the teacher, the learner, and of the learning context to: Develop clinically appropriate and contextually relevant simulation-based XR scenarios that teach students how to respect differences and beliefs in diverse populations whose world view may be different from ones’ own. Inform culturally-responsive teaching and learning in paramedicine education research and practice. Implementation of pedagogical strategies in paramedicine critical care simulation to enhance culturally-responsive understandings and practice.

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Patterson, Davis G., Cynthia Coulthard, Lisa A. Garberson, Gary Wingrove, and Eric H. Larson. "What Is the Potential of Community Paramedicine to Fill Rural Health Care Gaps?" Journal of Health Care for the Poor and Underserved 27, no. 4A (2016): 144–58. http://dx.doi.org/10.1353/hpu.2016.0192.

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King, Kelly, Sharon Neely, Rudy Dinglas, James Matz, and Mark Fletcher. "Mobile Integrated Health/Community Paramedicine: Improving Health and Reducing Cost in Baltimore City." Journal of Transport & Health 3, no. 2 (June 2016): S18. http://dx.doi.org/10.1016/j.jth.2016.05.054.

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Pang, Peter S., Megan Litzau, Mark Liao, Jennifer Herron, Elizabeth Weinstein, Christopher Weaver, Dan Daniel, and Charles Miramonti. "Limited data to support improved outcomes after community paramedicine intervention: A systematic review." American Journal of Emergency Medicine 37, no. 5 (May 2019): 960–64. http://dx.doi.org/10.1016/j.ajem.2019.02.036.

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Lau, Hunter Singh, Matthew M. Hollander, Jeremy T. Cushman, Eva H. DuGoff, Courtney M. C. Jones, Amy J. H. Kind, Michael T. Lohmeier, Eric A. Coleman, and Manish N. Shah. "Qualitative Evaluation of the Coach Training within a Community Paramedicine Care Transitions Intervention." Prehospital Emergency Care 22, no. 4 (February 12, 2018): 527–34. http://dx.doi.org/10.1080/10903127.2017.1419325.

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Choi, Bryan Y., Charles Blumberg, and Kenneth Williams. "Mobile Integrated Health Care and Community Paramedicine: An Emerging Emergency Medical Services Concept." Annals of Emergency Medicine 67, no. 3 (March 2016): 361–66. http://dx.doi.org/10.1016/j.annemergmed.2015.06.005.

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Leyenaar, M., B. McLeod, S. Penhearow, R. Strum, M. Brydges, A. Brousseau, E. Mercier, et al. "P085: What do community paramedics assess? An environmental scan and content analysis of patient assessment in community paramedicine." CJEM 21, S1 (May 2019): S94. http://dx.doi.org/10.1017/cem.2019.276.

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Introduction: Patient assessment is a fundamental feature of non-emergency community paramedicine (CP) home visit programs. In the absence of a recognized standard for CP assessment, current assessment practices in CP programs are unknown. Without knowing what community paramedics are assessing, it is difficult to ascertain what should be included in patient care plans, whether interventions are beneficial, or whether paramedics are meeting program objectives. Our objective was to summarize the content of assessment instruments used in CP programs in order to describe the state of current practice. Methods: We performed an environmental scan of all CP programs in Ontario, Canada, and employed content analysis to describe current assessment practices in CP home visit programs. The International Classification on Functioning, Disability, and Health (ICF) was used to categorize and compare assessments. Each item within each assessment form was classified according to the ICF taxonomy. Findings were compared at the domain and sub-domain of the ICF. Results: Of 54 paramedic services in Ontario, 43 responded to our request for information. Of 24 services with CP home visit programs, 18 provided their intake assessment forms for content analysis. Assessment forms contained between 13 and 252 assessment items (median 116.5, IQR 134.5). Overall, most assessments included some content from each of the domains outlined in the ICF, including: Impairments of Body Functions, Impairments of Body Structures, Activity Limitation and Participation, and Environmental Factors. At the sub-domain level, only assessment of Impairments of the Functions of the Cardiovascular, Haematological, Immunological and Respiratory systems appeared in all assessments. Few CP home visit program assessments covered most ICF sub-domain categories and many items classified to specific categories were included in only a few assessments. Conclusion: CP home visit programs complete multi-domain assessments as part of patient intake. The content of CP assessments varied across Ontario, which suggests that care planning and resources may not be consistent. Current work on practice guidelines and paramedic training can build from descriptions of assessment practices to improve quality of care and patient safety. By identifying what community paramedics assess, evaluation of the quality of CP home visit programs and their ability to meet program objectives can be improved and benchmarks in patient care can be established.

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Besserer, F., D. Banner-Lukaris, J. Tallon, and D. Kandola. "MP44: Implementing rural advanced care community paramedics in rural and remote British Columbia: a qualitative research approach." CJEM 22, S1 (May 2020): S58. http://dx.doi.org/10.1017/cem.2020.192.

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Introduction: Community paramedicine is well-established with an increasing evidence base to support its role in improving healthcare delivery in Canada and across the world. In British Columbia (BC), the BC Emergency Health Services (BCEHS) community paramedicine program provides an avenue to expand the Advanced Care Paramedic (ACP) role in underserved rural and remote communities across the province. Methods: We undertook stakeholder consultations using purposive sampling to better understand the barriers and facilitators impacting the integration of rural advanced care community paramedics (RACCPs) in 6 BC communities and to evaluate stakeholder perspectives of the implementation and impacts of the RACCP. 18 in-depth interviews were completed with a diverse range of stakeholders. The interviews were analyzed using a qualitative descriptive approach and the Theoretical Domains Framework. Results: A number of key facilitators and barriers to implementation of the RACCP were identified. Facilitators included the RACCP bridging significant gaps in existing community-based healthcare services including palliative care, harm reduction, and home-based assessment. The RACCP also provides leadership within their communities by actively engaging in the delivery of informal and formal debriefing, mentorship, and education. Identified barriers to RACCP implementation included confusion over the scope of the RACCP role, lack of shared health data, and various regulatory challenges. Several priority areas for ongoing development were also identified including workforce planning, addressing regulatory requirements, developing a strategic and systematic activation and dispatch process, providing continuing mentorship and supports for RACCPs, and the importance for ongoing engagement with end-users to determine the impact of the RACCP role for community health services. Conclusion: This research provides a strong foundation for addressing healthcare delivery in rural and remote BC by identifying the unique challenges communities face in healthcare provision and is a leading initiative for the ongoing development of professional paramedic practice across the province.

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Jagos, K., I. Drennan, M. McNamara, and J. Limoges. "P112: Strengthening inter-professional collaboration in home-based community paramedic programs." CJEM 22, S1 (May 2020): S105. http://dx.doi.org/10.1017/cem.2020.318.

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Introduction: Community paramedic programs are being implemented to leverage existing resources and contribute to a sustainable patient-centered healthcare system. Expanding the role of paramedics into home care requires new collaborative relationships with healthcare providers such as nurses and physicians. Developing effective and productive collaborative relationships will enhance and support the integration of community paramedic programs. Our objective was to describe the barriers and facilitators to effective collaboration between nurses, physicians, and paramedics within home-based community paramedicine. Methods: We conducted semi-structured interviews with nurses, physicians, paramedics, and faculty who teach in paramedic programs. We explored the attitudes, perceptions, barriers, and enablers to collaboration in home-based community paramedic programs. Participants were recruited utilizing the professional networks of the researchers as well as snowball sampling. Recruitment in each group stopped when saturation was achieved. We conducted a thematic analysis of the interviews to generate findings related to our objectives. Results: We interviewed 33 participants with a typical cross-section of age, years of experience, and education. Overall, participants felt that collaboration was important for effective integration of community paramedics into home care and for ensuring a patient-centered approach to care. Currently, collaboration mostly occurs between physicians and paramedics and community paramedicine appears to be a siloed rather than integrated service. Few collaborative relationships exist between paramedics and nurses, despite the fact that nurses are highly involved in home care. We identified several barriers to effective collaboration including lack of understanding of the contributions of the different health providers, and regulatory and funding constraints. Inter-professional education that supports collaboration and facilitates dismantling of professional and service silos can support the effective integration of paramedics into home care. Conclusion: Strengthening networks of collaboration between nurses, physicians, and paramedics can help dismantle silos and enhance inter-professional collaboration to support appropriate integration of paramedics into home care. The willingness and positive attitudes for collaboration are assets that provide an excellent foundation upon which to move forward. Continuing education to support inter-professional collaboration is needed.

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Brady, N., D. Gingold, and B. Stryckman. "361 Analyzing Risk Factors for Readmission in a Mobile Integrated Health: Community Paramedicine Population." Annals of Emergency Medicine 78, no. 4 (October 2021): S145. http://dx.doi.org/10.1016/j.annemergmed.2021.09.376.

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Hickson, Helen, Peter O'Meara, and Chris Huggins. "Engaging in community conversation: A means to improving the paramedicine student clinical placement experience." Action Research 12, no. 4 (August 8, 2014): 410–25. http://dx.doi.org/10.1177/1476750314546572.

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Journal articles on the topic 'Community paramedicine'

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