Contribution of paramedics in primary and urgent care: a systematic review

Eaton, Georgette; Wong, Geoff; Williams, Veronika; Roberts, Nia; Mahtani, Kamal R

doi:10.3399/bjgp20x709877

Cited by 43 publications

(55 citation statements)

References 22 publications

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“…We used our exploratory scoping of the literature [ 21 ] to develop an initial programme theory (Fig. 1 ) to explain how paramedics work in primary care.…”

Section: Methodsmentioning

confidence: 99%

“…Whilst paramedics may be primed to work well in primary care, as they transition into these roles, their knowledge and skillset will undoubtedly change [ 3 , 4 , 13 ]. Our recent scoping review of evidence published since 2005 [ 21 ] outlined that paramedics can safely apply their extended skills to assess and treat patients in primary care, but there were conflicts in relation to job titles, roles and responsibilities. Despite this, the role was received positively by patients.…”

Section: Introductionmentioning

confidence: 99%

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Understanding the role of the paramedic in primary care: a realist review

Eaton

Wong

Tierney

et al. 2021

BMC Med

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Background Since 2002, paramedics have been working in primary care within the United Kingdom (UK), a transition also mirrored within Australia, Canada and the USA. Recent recommendations to improve UK NHS workforce capacities have led to a major push to increase the numbers of paramedics recruited into primary care. However, gaps exist in the evidence base regarding how and why these changes would work, for whom, in what context and to what extent. To understand the ways in which paramedics impact (or not) the primary care workforce, we conducted a realist review. Methods A realist approach aims to provide causal explanations through the generation and articulation of contexts, mechanisms and outcomes. Our search of electronic databases was supplemented with Google and citation checking to locate grey literature including news items and workforce reports. Included documents were from the UK, Australia, Canada and the Americas—countries within which the paramedic role within primary care is well established. Results Our searches resulted in 205 included documents, from which data were extracted to produce context-mechanism-outcome configurations (CMOCs) within a final programme theory. Our results outline that paramedics are more likely to be effective in contributing to primary care workforces when they are supported to expand their existing role through formal education and clinical supervision. We also found that unless paramedics were fully integrated into primary care services, they did not experience the socialisation needed to build trusting relationships with patients or physicians. Indeed, for patients to accept paramedics in primary care, their role and its implications for their care should be outlined by a trusted source. Conclusions Our realist review highlights the complexity surrounding the introduction of paramedics into primary care roles. As well as offering an insight into understanding the paramedic professional identity, we also discuss the range of expectations this professional group will face in the transition to primary care. These expectations come from patients, general practitioners (family physicians) and paramedics themselves. This review is the first to offer insight into understanding the impact paramedics may have on the international primary care workforce and shaping how they might be optimally deployed.

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“…We used our exploratory scoping of the literature [ 21 ] to develop an initial programme theory (Fig. 1 ) to explain how paramedics work in primary care.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Understanding the role of the paramedic in primary care: a realist review

Eaton

Wong

Tierney

et al. 2021

BMC Med

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“…This study provides important insights into the integration of alternative, extended-scope practitioners to GPs in the delivery of medical care to homebound patients, an important consideration for primary care in the UK and European countries [19]. Our work adds to the emerging evidence of practitioners, such as paramedics and ECPs, performing primary care healthcare roles, which describes positive experiences of health professionals and patients [5,8,9,14].…”

Section: Links With the Existing Evidence Basementioning

confidence: 89%

“…More recent work on integrating physician associates in primary care suggests that professional boundaries can be redefined at the GP practice level [13]. Despite recent work exploring how paramedics may be deployed in primary care, there is a paucity of evidence about how to embed such practitioners into primary care teams [5,14].…”

Section: Introductionmentioning

confidence: 99%

Future-proofing the primary care workforce: A qualitative study of home visits by emergency care practitioners in the UK

Barker

Stocker

Russell

et al. 2021

European Journal of General Practice

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“…20(para.1.17) A recent systematic review of the contribution of paramedics in primary care suggests that this may be an appealing career move for many paramedics wishing to further develop their professional practice, and that paramedics are among the group of allied health professionals who are attractive to GP surgeries based on this funding. 21 Paramedics working in primary care settings have been shown to decrease GP workload by assessing and treating urgent, non-complex patients: 22,23 however, if patients must subsequently see a GP in order to have certain medicines prescribed, paramedic independent prescribers may seem like a less attractive hire than either nurses or pharmacists. 24 In such cases, patients may fail to see the purpose of an assessment undertaken by a paramedic.…”

Section: Clinical Consequencesmentioning

confidence: 99%

UK non‐medical CD prescribing law: permissive or restrictive?

Gallagher

2021

Prescriber

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N ursing and pharmacy were the first professions permitted to engage in independent non-medical prescribing following an amendment to regulation (reg.) 2 of the Prescription Only Medicines (Human Use) Order 1997 (POM Order) in May 2006. 1 Optometrists were added to this list of prescribers or "appropriate practitioners" in June 2008. 2 Continuation of the list was transferred to reg. 214 of the Human Medicines Regulations 2012 (HMRs), which repealed much of the POM Order, in August 2012. Since that time, other professions have gained independent prescribing rights under the HMRs. These include: podiatrists and physiotherapists in August 2013; 3 therapeutic radiographers in April 2016; 4 and paramedics in April 2018. 5 Reg. 214 of the HMRs stipulate which medicines-specifically, those containing certain controlled drugs (CDs)-that each group of appropriate practitioners are permitted to prescribe. Doctors, dentists, supplementary prescribers (ie non-medical prescribers working under the terms of a clinical management plan co-signed by a doctor or dentist), nurse independent prescribers and pharmacist independent prescribers are appropriate practitioners in relation to any prescription only medicine

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Contribution of paramedics in primary and urgent care: a systematic review

Cited by 43 publications

References 22 publications

Understanding the role of the paramedic in primary care: a realist review

Understanding the role of the paramedic in primary care: a realist review

Future-proofing the primary care workforce: A qualitative study of home visits by emergency care practitioners in the UK

UK non‐medical CD prescribing law: permissive or restrictive?

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