Health service utilization by people experiencing homelessness and engaging with community paramedics: a pre–post study

Taplin, John; Barnabe, C. M.; Blanchard, Ian E.; Doig, Christopher J.; Crowshoe, L.; Clement, F. M.

doi:10.1007/s43678-022-00387-w

Cited by 5 publications

(8 citation statements)

References 10 publications

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“…People experiencing homelessness and/or experiencing poverty were identified as key populations facing structural barriers to health and wellness in 30 of the studies (70%) [34,43,[47][48][49]. A total of 22 studies (51%) featured home-visit program models, while 11 studies (25.5%) described programs that adapted to create outreach services, specifically addressing the needs of people experiencing homelessness [34,40,43,44,49].…”

Section: Domain 2 -Daily Livingmentioning

confidence: 99%

“…Community paramedics encounter a high proportion of individuals with complex health, including mental health needs, that could benefit from further integration of care [53,54]. In response to high health system utilisation by people experiencing homelessness, and building on proven effectiveness of mobile outreach, an innovative "City Centre Team" (CCT) was created in a major Canadian city to focus care needs on people who are unhoused with a high prevalence of substance use [34,38,47]. Evaluation demonstrated the capability of community paramedicine to address health and social needs of people experiencing homelessness by using interdisciplinary and interprofessional collaboration and communication across community, social, and health services.…”

Section: Domain 3 -Mental Health and Substance Usementioning

confidence: 99%

“…The proximity that community paramedics have to individuals' home and work life enables them to assess for harmful physical environments like elder abuse and intimate partner violence. 47 While individuals and communities are not inherently vulnerable, groups made vulnerable due to cultural isolation and systemic and structural inequities such as discrimination on the basis of age, gender, sexuality, race, culture, refugee or immigration status, and incarceration were identified as populations that community paramedics encounter [1,27,28,51,57]. There were no data indicating the ways in which community paramedics are trained to consider inequities due to structural and systemic discrimination in their approach.…”

Section: Domain 5 -Social Support Agency and Belongingmentioning

confidence: 99%

“…It is important to determine key elements to inform a framework guiding community needs assessments. To address healthcare inequities that are a result of system-centred programming, those developing community paramedicine must commit to codesigning service models, specifically including perspectives from structurally marginalised groups [27,47,83]. Considering an intersectional lens, paramedicine leaders will require guidance on how to engage in equitable stakeholder engagement, including amplifying voices of people receiving care and their caregivers.…”

Section: Future Directionsmentioning

confidence: 99%

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Community Paramedicine Supporting Community Needs: A Scoping Review<strong></strong>

Lunn,

Bolster,

Batt

2024

Preprint

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Health and social needs exist along a dynamic continuum. Recognizing that health status is inextricably impacted by social determinants of health, community paramedicine has opportunities and a responsibility to reduce inequities. The objective of this scoping review was to investigate peer-reviewed and grey literature to explore how community paramedicine supports community needs along a health and social continuum. We conducted a scoping review of English language literature using the JBI Scoping Review methodology. We searched CINAHL, EMBASE, MEDLINE, Google Scholar, and organisational websites. 30 peer-reviewed and 13 grey literature articles met inclusion criteria. The findings describe the ways community paramedicine models evolved from minimising system pressures on emergency health services to addressing health and social needs. A key recommendation across the literature was the need to meaningfully engage communities early in program development to understand how best to implement and co-design integrated service models addressing specific community needs, though there was a lack of evidence to guide this approach. There is a notable lack of evidence pertaining to optimising technologies in program design and implementation. Results highlight opportunities to determine best practices for conducting holistic community needs assessments that include equitable stakeholder engagement and enhancing education to prepare paramedics for expanded roles. Community paramedicine provides opportunities to better meet the needs of structurally marginalised communities. There is a social responsibility and opportunity to engage communities to co-design service delivery, advance paramedic education, and enhance interprofessional collaboration to better support community needs and generate upstream solutions for individuals and communities.

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Section: Domain 2 -Daily Livingmentioning

confidence: 99%

Section: Domain 3 -Mental Health and Substance Usementioning

confidence: 99%

Section: Domain 5 -Social Support Agency and Belongingmentioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

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Community Paramedicine Supporting Community Needs: A Scoping Review<strong></strong>

Lunn,

Bolster,

Batt

2024

Preprint

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“…These groups are often picked up in crisis situations as a direct result of inequitable access. 36,37…”

Section: Utility Of Ems In a Public Health Palliative Care Approachmentioning

confidence: 99%

Emergency medical services: the next linking asset for public health approaches to palliative care?

2023

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Emergency medical services (EMS) are a unique workforce providing 24/7 emergency care across high-income countries (HICs) and low- and middle-income countries (LMICs). Although traditionally perceived as first responders to traumatic and medical emergencies, EMS scope of practice has evolved to respond to the changing needs of communities, including a growing demand for community-based palliative care. Public health provides a useful framework to conceptualise palliative and end-of-life care in community-based settings. However, countries lack public policy frameworks recognising the role EMS can play in initiating palliative approaches in the community, facilitating goals of care at end of life and transporting patients to preferred care settings. This article aims to explore the potential role of EMS in a public health palliative care approach in a critical discussion essay format by (1) discussing the utility of EMS within a public health palliative care approach, (2) identifying the current barriers preventing public health approaches to EMS palliative care provision and (3) outlining a way forward through priorities for future research, policy, education and practice. EMS facilitate equitable access, early provision, expert care and efficacious integration of community-based palliative care. However, numerous structural, cultural and practice barriers exist, appearing ubiquitous across both HICs and LMICs. A Public Health Palliative Care approach to EMS Framework highlights the opportunity for EMS to work as a linking asset to build capacity and capability to support palliative care in place; connect patients to health and community supports; integrate alternative pathways by engaging multidisciplinary teams of care; and reduce avoidable hospital admissions by facilitating home-based deaths. This article articulates a public health approach to EMS palliative and end-of-life care provision and offers a preliminary framework to illustrate the components of a potential implementation and policy strategy.

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Reflections on the past and optimism for the future: the potential for paramedicine to contribute to health care system improvements and the critical need for research

Blanchard,

Jensen,

Bigham

2023

Can J Emerg Med

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Health service utilization by people experiencing homelessness and engaging with community paramedics: a pre–post study

Cited by 5 publications

References 10 publications

Community Paramedicine Supporting Community Needs: A Scoping Review<strong></strong>

Community Paramedicine Supporting Community Needs: A Scoping Review<strong></strong>

Emergency medical services: the next linking asset for public health approaches to palliative care?

Reflections on the past and optimism for the future: the potential for paramedicine to contribute to health care system improvements and the critical need for research

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