No abstract

Aim: This longitudinal study was designed to address four research questions and the hypothesis; that adults living in a rural community receiving primary health care and emergency services from a team that included an on-site nurse practitioner (NP) and paramedics and an off-site family physician would, over time, demonstrate evidence of improved psychosocial adjustment and less expenditure of health care resources. Background: In Canada, there is a growing awareness and commitment to addressing the challenges of providing primary health care services in rural areas. A literature review supported the role of NPs in primary health care and a potential role for paramedics. No studies were found that evaluated the combination of NPs, paramedics and physicians as providers of primary health care. Methods: Structured questionnaires, individual and group interviews with patients, health and social service care providers and administrators and community members were used to describe and evaluate the impact of the model of care over the three years of the study. Findings: The innovative model of care resulted in decreased cost, increased access, a high level of acceptance and satisfaction and effective collaboration among care providers. Organizational structures to support the innovative model of primary health care were identified.

No abstract

Objectives: Long-term care (LTC) patients are often sent to ennergency departnnents (EDs) by ambulance. In this novel extended care paramedic (ECP) program, specially trained paramedics manage LTC patients on site. The objective of this pilot study was to describe the dispatch and disposition of LTC patients treated by ECPs and emergency paramedics. Methods: Data were collected from consecutive calls to 15 participating LTC facilities for 3 months. Dispatch determinants, transport rates, and relapse rates were described for LTC patients attended by ECPs or emergency paramedics. ECP involvement in end-of-life care was identified. Results: Of 238 eligible calls, 140 (59%) were attended by an ECP and 98 (41%) by emergency paramedics. Although the top three determinants were the same in each group, the overall distribution of dispatch determinants and acuity differed. In the ECP cohort, 98 of 140 (70%) were treated and released, 33 of 140 (24%) had "facilitated transfer" arranged by an ECP, and 9 of 140 (6%) were immediately transported to the ED by ambulance. In the emergency paramedic cohort, 77 of 98 (79%) were immediately transported to the ED and 21 of 98 (21%) were not transported. In the ECP group, 6 of 98 (6%) patients not transported triggered a 911 call within 48 hours for a related clinical reason, although none of the patients not transported by emergency paramedics relapsed.Conclusion: ECP involvement in LTC calls was found to reduce transports to the ED with a low rate of relapse. These pilot data generated hypotheses for future study, including determination of appropriate populations for ECP care and analysis of appropriate and safe nontransport. RÉSUMÉObjectif: Les personnes résidant dans des établissements de soins prolongés (SP) sont souvent transportées en ambulance aux services des urgences (SU). Dans le cadre d'un nouveau programme de soins paramédicaux prolongés (SPP), des ambulanciers paramédicaux spécialement formés évaluent, sur place, l'état de résidants d'établissements de SP. L'étude pilote dont il sera question ici visait à faire état de l'aiguillage et du sort de résidants d'établissements de SP, examinés par des ambulanciers spécialisés en SPP ou par des ambulanciers paramédicaux d'urgence. Méthode: II y a eu collecte de données à partir d'appels consécutifs, faits dans 15 établissements de SP participants, sur une période de 3 mois. Suivent une description des déterminants de l'aiguillage de résidants d'établissements de SP, examinés par des ambulanciers spécialisés en SPP ou par des ambulanciers paramédicaux d'urgence, ainsi que le calcul des taux de transport et de rechute. Les interventions relatives aux SPP en fin de vie ont également été notées. Résultats: Sur 238 appels recevables, 140 patients (59 %) ont été examinés par des ambulanciers spécialisés en SPP et 98 patients (41 %), par des ambulanciers paramédicaux d'urgence. Bien que les trois principaux déterminants étaient les mêmes dans chacun des groupes, la répartition générale des détermi-nants de l'aiguillage et le degré d...