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

Abstract

Background: Community paramedicine (CP) leverages trained emergency medical services personnel outside of emergency response as an innovative model of health care delivery. Often used to bridge local gaps in healthcare delivery, the CP model has existed for decades. Recently, the number of programs has increased. However, the level of robust data to support this model is less well known.

“They’re very passionate about making sure that women stay healthy”: a qualitative examination of women’s experiences participating in a community paramedicine program

“…Because of these changes to licensing and medical director requirements, community paramedicine has also evolved. Community paramedicine programs have been implemented in communities across the United States and throughout the world [ 10 – 16 ]. In almost all instances, community paramedicine programs have provided care for older adults with chronic illness in rural areas [ 12 – 16 ].…”

“…Community paramedicine programs have been implemented in communities across the United States and throughout the world [ 10 – 16 ]. In almost all instances, community paramedicine programs have provided care for older adults with chronic illness in rural areas [ 12 – 16 ]. More recently, some programs have shifted the focus to provide care to children with chronic disease or frequent users of the emergency medical services (EMS) system, and numerous programs operate in urban areas [ 13 , 17 ].…”

“…Community paramedicine programs have a long history and are becoming increasingly common, but their value and effectiveness in the United States have not been extensively studied [ 13 – 16 ]. The small body of available literature on community paramedicine, which has primarily focused on older adult health and frequent EMS users, demonstrates high patient satisfaction levels, reductions in ER visits and hospital readmission, and reductions in costs of care [ 13 , 31 , 32 ].…”

Using Mobile Integrated Health and telehealth to support transitions of care among patients with heart failure (MIGHTy-Heart): protocol for a pragmatic randomised controlled trial

“…Community paramedicine addresses acute symptom exacerbations, educates patients and performs preventive measures in the home (eg, medication reconciliation and fall prevention). [20][21][22] Licensed emergency medical technicians and paramedics complete additional training to become community paramedics including didactic courses, casebased simulation, in-home and clinic-based observations, all with a specific focus in geriatric medicine. During in-home MIH evaluations, the paramedics perform a standardised assessment, then video conference with a telehealth physician who directs additional diagnostics (eg, point-of-care lab testing), therapeutics (eg, administering intravenous diuretics) or care coordination (eg, referral to special providers).…”

“…MIH uses the skills and training of community paramedics collaboratively with on-demand telehealth supervision by physicians13 to remotely manage medically complex patients at high-risk for readmission. Community paramedicine addresses acute symptom exacerbations, educates patients and performs preventive measures in the home (eg, medication reconciliation and fall prevention) 20–22. Licensed emergency medical technicians and paramedics complete additional training to become community paramedics including didactic courses, case-based simulation, in-home and clinic-based observations, all with a specific focus in geriatric medicine.…”