Introduction of an extended care paramedic model in <scp>N</scp>ew <scp>Z</scp>ealand

Hoyle, S.; Swain, Andrew; Fake, Paul; Larsen, Peter

doi:10.1111/j.1742-6723.2012.01608.x

Cited by 26 publications

(33 citation statements)

References 10 publications

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“…Our review of titles and abstracts suggested that 138 articles might be eligible. After studying full texts, we confirmed that 13 papers 61,62,66,80,[89][90][91][92][93][94][95][96][97] reporting 12 studies met our inclusion criteria, as detailed in Figure 1. Table 4 summarises the 12 included studies; Tables 5 and 6 describe them in more detail and Table 7 assesses their quality.…”

Section: Inclusionmentioning

confidence: 56%

“…The most common outcome measures were referrals made to a receiving unit or service, 66,89,[91][92][93]97 acceptance of referral by the patient 66,89,91,92,97 and patient conveyance following attendance by EMSs. 66,80,95 Five studies reported follow-up outcomes for patients receiving a novel intervention (see Table 6). 61,66,80,90,97 Three 66,80,90 used short follow-up periods (14 and 28 days) with limited inclusion of outcome measures in two, 80,90 whereas another collected physical health, quality-of-life and mortality outcomes.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The one-armed nature of six 89,[91][92][93]95,97 of the studies restricted them to reporting descriptive outcomes. All but Logan et al 61 reported outcomes at the time of the intervention or soon after.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Of the 12 studies, six 61,62,66,80,89,94 came from the UK, four [90][91][92][93] came from the USA, one 97 came from Australia and one 95 came from New Zealand. Study designs comprised two RCTs 61,66 (one of which 61 published a separate paper evaluating cost-effectiveness element of the study), 62 nine cohort studies (of which six did not include a comparator arm 89,[91][92][93]95,97 and three included intervention and control arms 80,90,96 ) and one qualitative study.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Study designs comprised two RCTs 61,66 (one of which 61 published a separate paper evaluating cost-effectiveness element of the study), 62 nine cohort studies (of which six did not include a comparator arm 89,[91][92][93]95,97 and three included intervention and control arms 80,90,96 ) and one qualitative study. 94 Of the nine cohort studies, three were retrospective, 92,95,96 five were prospective 80,[89][90][91]97 and one had both prospective (screening) and retrospective (referral) elements. 93 These study characteristics are summarised in Table 4.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Support and Assessment for Fall Emergency Referrals (SAFER) 2: a cluster randomised trial and systematic review of clinical effectiveness and cost-effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community-based care when appropriate

Snooks

Anthony

Chatters

et al. 2017

Health Technol Assess

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Background: Emergency calls are frequently made to ambulance services for older people who have fallen, but ambulance crews often leave patients at the scene without any ongoing care. We evaluated a new clinical protocol which allowed paramedics to assess older people who had fallen and, if appropriate, refer them to community-based falls services.\ud Objectives: To compare outcomes, processes and costs of care between intervention and control groups; and to understand factors which facilitate or hinder use.\ud Design: Cluster randomised controlled trial.\ud Participants: Participating paramedics at three ambulance services in England and Wales were based at stations randomised to intervention or control arms. Participants were aged 65 years and over, attended by a study paramedic for a fall-related emergency service call, and resident in the trial catchment areas.\ud Interventions: Intervention paramedics received a clinical protocol with referral pathway, training and support to change practice. Control paramedics continued practice as normal.\ud Outcomes: The primary outcome comprised subsequent emergency health-care contacts (emergency admissions, emergency department attendances, emergency service calls) or death at 1 month and 6 months. Secondary outcomes included pathway of care, ambulance service operational indicators, self-reported outcomes and costs of care. Those assessing outcomes remained blinded to group allocation.\ud Results: Across sites, 3073 eligible patients attended by 105 paramedics from 14 ambulance stations were randomly allocated to the intervention group, and 2841 eligible patients attended by 110 paramedics from 11 stations were randomly allocated to the control group. After excluding dissenting and unmatched patients, 2391 intervention group patients and 2264 control group patients were included in primary outcome analyses. We did not find an effect on our overall primary outcome at 1 month or 6 months. However, further emergency service calls were reduced at both 1 month and 6 months; a smaller proportion of patients had made further emergency service calls at 1 month (18.5% vs. 21.8%) and the rate per patient-day at risk at 6 months was lower in the intervention group (0.013 vs. 0.017). Rate of conveyance to emergency department at index incident was similar between groups. Eight per cent of trial eligible patients in the intervention arm were referred to falls services by attending paramedics, compared with 1% in the control arm. The proportion of patients left at scene without further care was lower in the intervention group than in the control group (22.6% vs. 30.3%). We found no differences in duration of episode of care or job cycle. No adverse events were reported. Mean cost of the intervention was £17.30 per patient. There were no significant differences in mean resource utilisation, utilities at 1 month or 6 months or quality-adjusted life-years. In total, 58 patients, 25 paramedics and 31 stakeholders participated in focus groups or interviews. Patients were very satisfied ...

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Section: Inclusionmentioning

confidence: 56%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Support and Assessment for Fall Emergency Referrals (SAFER) 2: a cluster randomised trial and systematic review of clinical effectiveness and cost-effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community-based care when appropriate

Snooks

Anthony

Chatters

et al. 2017

Health Technol Assess

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The Economic Impact of Community Paramedics Within Emergency Medical Services: A Systematic Review

Wilkinson-Stokes,

Tew,

Yap

et al. 2024

Appl Health Econ Health Policy

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Background and Objective Globally, emergency medical services (EMSs) report that their demand is dominated by non-emergency (such as urgent and primary care) requests. Appropriately managing these is a major challenge for EMSs, with one mechanism employed being specialist community paramedics. This review guides policy by evaluating the economic impact of specialist community paramedic models from a healthcare system perspective. Methods A multidisciplinary team (health economics, emergency care, paramedicine, nursing) was formed, and a protocol registered on PROSPERO (CRD42023397840) and published open access. Eligible studies included experimental and analytical observational study designs of economic evaluation outcomes of patients requesting EMSs via an emergency telephone line (‘000’, ‘111’, ‘999’, ‘911’ or equivalent) responded to by specialist community paramedics, compared to patients attended by usual care (i.e. standard paramedics). A three-stage systematic search was performed, including Peer Review of Electronic Search Strategies (PRESS) and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Two independent reviewers extracted and verified 51 unique characteristics from 11 studies, costs were inflated and converted, and outcomes were synthesised with comparisons by model, population, education and reliability of findings. Results Eleven studies ( n = 7136 intervention group) met the criteria. These included one cost-utility analysis (measuring both costs and consequences), four costing studies (measuring cost only) and six cohort studies (measuring consequences only). Quality was measured using Joanna Briggs Institute tools, and was moderate for ten studies, and low for one. Models included autonomous paramedics (six studies, n = 4132 intervention), physician oversight (three studies, n = 932 intervention) and/or special populations (five studies, n = 3004 intervention). Twenty-one outcomes were reported. Models unanimously reduced emergency department (ED) transportation by 14–78% (higher quality studies reduced emergency department transportation by 50–54%, n = 2639 intervention, p < 0.001), and costs were reduced by AU$338–1227 per attendance in four studies ( n = 2962). One study performed an economic evaluation ( n = 1549), finding both that the costs were reduced by AU$454 per attendance (although not statistically significant), and consequently that the intervention dominated with a > 95% chance of the model being cost effective at the UK incremental cost-effectiveness ratio threshold. Conclusions Community paramedic roles within EMSs reduced ED transportation by approximately half. However, the rate was highly variable owing to structural (such as local...

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Limited data to support improved outcomes after community paramedicine intervention: A systematic review

Pang

Litzau

Liao

et al. 2019

The American Journal of Emergency Medicine

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Introduction of an extended care paramedic model in New Zealand

Cited by 26 publications

References 10 publications

The Economic Impact of Community Paramedics Within Emergency Medical Services: A Systematic Review

Limited data to support improved outcomes after community paramedicine intervention: A systematic review

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