Perspectives from the frontline of two North American community paramedicine programs: an observational, ethnographic study.
TL;DR: Improved education and communication from paramedic service management with staff and external stakeholders might improve transitional processes and better support a culture of inclusivity for community paramedicine programs.
Abstract: Introduction Community paramedicine is one emerging model filling gaps in rural healthcare delivery. It can expand the reach of primary care and public health service provision in underserviced rural communities through proactive engagement of paramedics in preventative care and chronic disease management. This study addressed key research priorities identified at the National Agenda for Community Paramedicine Research conference in Atlanta, USA in 2012. The motivations, job satisfaction and challenges from the perspectives of community paramedics and their managers pioneering two independent programs in rural North America were identified. Methods An observational ethnographic approach was used to acquire qualitative data from participants, through informal discussions, semi-structured interviews, focus groups and direct observation of practice. During field trips over two summers, researchers purposively recruited participants from Ontario, Canada and Colorado, USA. These sites were selected on the basis of uncomplicated facilitation of ethics and institutional approval, the diversity of the programs and willingness of service managers to welcome researchers. Thematic analysis techniques were adopted for transcribing, de-identifying and coding data that allowed identification of common themes. Results This study highlighted that the innovative nature of the community paramedic role can leave practitioners feeling misunderstood and unsupported by their peers. Three themes emerged: the motivators driving participation, the transitional challenges facing practitioners and the characteristics of paramedics engaged in these roles. A major motivator is the growing use of ambulances for non-emergency calls and the associated need to develop strategies to combat this phenomenon. This has prompted paramedic service managers to engage stakeholders to explore ways they could be more proactive in health promotion and hospital avoidance. Community paramedicine programs are fostering collaborative partnerships between disciplines, while the positive outcomes for patients and health cost savings are tangible motivators for paramedic services and funders. Paramedics were motivated by a genuine desire to make a difference and attracted to the innovative nature of a role delivering preventative care options for patients. Transitional challenges included lack of self-regulation, navigating untraditional roles and managing role boundary tensions between disciplines. Community paramedics in this study were largely self-selected, genuinely interested in the concept and proactively engaged in the grassroots development of these programs. These paramedics were comfortable integrating and operating within multidisciplinary teams. Conclusions Improved education and communication from paramedic service management with staff and external stakeholders might improve transitional processes and better support a culture of inclusivity for community paramedicine programs. Experienced and highly motivated paramedics with excellent communication and interpersonal skills should be considered for community paramedic roles. Practitioners who are proactive about community paramedicine and self-nominate for positions transition more easily into the role: they tend to see the 'bigger picture', have broader insight into public health issues and the benefits of integrative health care. They are more likely to achieve higher job satisfaction, remain in the role longer, and contribute to better long-term program outcomes. Paramedic services and policymakers can use these findings to incentivize career pathways in community paramedicine and understand those changes that might better support this innovative model.
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TL;DR: Compared with the BEMT group, transport by the ELST group was associated with better neurological outcomes in OHCA, and ELSTs' limited procedure range did not promote favorable neurological outcomes.
15 citations
TL;DR: Active participation of stakeholders in the process of introducing CP programs, where people are comfortable questioning current practices and encouraged to explore new concepts and innovations, would enable a shared understanding of program aims and expectations.
Abstract: IntroductionCommunity paramedicine (CP) is an emerging model of care which expands paramedic scopes of practice to collaboratively support primary healthcare delivery in underserviced and disadvantaged communities. CP is a patient-centred holistic approach focussed on improving health outcomes, with success heavily reliant on integrative partnerships. This research aimed to identify key stakeholder perspectives about the value of CP in rural Australia.MethodsA workshop was conducted using a modified soft system methodology (SSM) that asked participants to consider the value of CP from the perspective of five key stakeholder groups. The 50 participants consisted of paramedics and volunteer ambulance officers, paramedic service executives, paramedic educators, Medicare Local representatives and a general practitioner. Participants were randomly allocated to five stakeholder groups: paramedic profession; Minister for Health and Ageing; consumers, chief executive and executive management team of an ambulance service; and healthcare professionals. The application of SSM placed the five groups into three broad categories of stakeholders: customers, actors, and owners.‘Customers’ in this context are patients, families and carers. ‘Actors’ are paramedics and volunteer ambulance officers, and ambulance service executives. The ‘owners’ are the Office of the Minister and those with the power to facilitate or block initiatives. Participants were allocated 15 minutes to brainstorm the question: “What can a community paramedic do for you to improve rural health provision?” Group views were verbally shared with all workshop participants and video recorded for analysis.ResultsThe ‘customers’ asked about CP from patient, family and carer perspectives, and were highly engaged with questions about how, when and where CP could operate. The paramedic and volunteer ambulance officer group of ‘actors’ battled to move beyond their emergency response mindset to articulate a clear CP vision. The executive management team responded from a strategic and risk management perspective focussing on patient safety and corporate image. They identified the need to form stakeholder partnerships. The ‘owners’ representing the Office of the Minister focussed on the holistic and wellness benefits of CP. The health professional group anticipated the CP role could provide collaborative care and support doctors.ConclusionsThe findings suggest many participants had a limited understanding of CP, which creates a barrier for implementation. Key benefits identified included a reduction in financial and physical burdens on the rural healthcare sector and improved outcomes for consumers. Active participation of stakeholders in the process of introducing CP programs, where people are comfortable questioning current practices and encouraged to explore new concepts and innovations, would enable a shared understanding of program aims and expectations. For paramedic services to expand service delivery models in rural Australia community participation and engagement with stakeholders is essential. They and paramedics must be willing to embrace meaningful and collaborative partnerships with patients, broader health networks, social services, politicians and researchers, and be prepared to step away from their traditional ‘command and control’ culture to co-design innovative paramedic models. SSM was a worthwhile approach to stakeholder engagement that has the potential to improve implementation of community paramedic programs through improved inclusion and the valuing of stakeholder perspectives.
9 citations
Cites background from "Perspectives from the frontline of ..."
...CP, particularly in North American studies (2,3,9-18), evidence...
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TL;DR: The outcome measures reported show that there is evidence to support the implementation of community paramedicine into healthcare system design, and a need to develop common approaches to education and scope of role while maintaining flexibility in addressing community needs.
Abstract: Abstract Community paramedic roles are expanding internationally, and no review of the literature could be found to guide services in the formation of community paramedicine programmes. For this reason, the aim of this restricted review was to explore and better understand the successes and learnings of community paramedic programmes across five domains being; education requirements, models of delivery, clinical governance and supervision, scope of roles and outcomes. This restricted review was conducted by searching four databases (CENTRAL, ERIC, EMBASE, MEDLINE and Google Scholar) as well as grey literature search from 2001 until 28/12/2021. After screening, 98 articles were included in the narrative synthesis. Most studies were from the USA (n = 37), followed by Canada (n = 29). Most studies reported on outcomes of community paramedicine programmes (n = 50), followed by models of delivery (n = 28). The findings of this review demonstrate a lack of research and understanding in the areas of education and scope of the role for community paramedics. The findings highlight a need to develop common approaches to education and scope of role while maintaining flexibility in addressing community needs. There was an observable lack of standardisation in the implementation of governance and supervision models, which may prevent community paramedicine from realising its full potential. The outcome measures reported show that there is evidence to support the implementation of community paramedicine into healthcare system design. Community paramedicine programmes result in a net reduction in acute healthcare utilisation, appear to be economically viable and result in positive patient outcomes with high patient satisfaction with care. There is a developing pool of evidence to many aspects of community paramedicine programmes. However, at this time, gaps in the literature prevent a definitive recommendation on the impact of community paramedicine programmes on healthcare system functionality.
7 citations
Dissertation•
19 Feb 2019
TL;DR: This paper presents a co-Authorship statement for the second part of a two-part treatment of co-authors’ contributions to the publication of the first part of this book.
Abstract: ........................................................................................................................ iii Paper 1 Co-Authorship Statement .................................................................................. iv Paper 2 Co-Authorship Statement ................................................................................... v Acknowledgments ......................................................................................................... vi Table of
6 citations
Cites background from "Perspectives from the frontline of ..."
...There has been research that has studied the patient perspectives of Ontario CP programs (Russell et al, 2017; Brydges et al., 2016 ; O’Meara et al., 2016 ; Martin & O’Meara, 2019), however there is a paucity of literature related to paramedic perspectives of CP....
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...Developing a job identity is still an issue that paramedics encounter, however CP developments may contribute to the development of a paramedic profession (Martin & O’Meara, 2019)....
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TL;DR: The Alternative Pre-Hospital Pathway (APP) Team as mentioned in this paper is one such Community Emergency Medicine (CEM) initiative developed in Cork, Ireland to target low acuity emergency calls.
Abstract: Internationally increasing demand for emergency care is driving innovation within emergency services. The Alternative Pre-Hospital Pathway (APP) Team is one such Community Emergency Medicine (CEM) initiative developed in Cork, Ireland to target low acuity emergency calls. In this paper the inception of the APP Team is described, and an observational descriptive analysis of the APP Team’s service data presented for the first 12 months of operation. The aim of this study is to describe and analyse the APP team service. The APP Team, consisting of a Specialist Registrar (SpR) in Emergency Medicine (EM) and an Emergency Medical Technician (EMT) based in Cork, covers a mixed urban and rural population of approximately 300,000 people located within a 40-min drive time of Cork University Hospital. The team are dispatched to low acuity 112/999 calls, aiming to provide definitive care or referring patients to the appropriate community or specialist service. A retrospective analysis was performed of the team’s first 12 months of operation using the prospectively maintained service database. Two thousand and one patients were attended to with a 67.8% non-conveyance rate. The median age was 62 years, with 33.0% of patients aged over 75 years. For patients over 75 years, the non-conveyance rate was 62.0%. The average number of patients treated per shift was 7. Medical complaints (319), falls (194), drug and alcohol related presentations (193), urological (131), and respiratory complaints (119) were the most common presentations. Increased demand for emergency care and an aging population is necessitating a re-design of traditional models of emergency care delivery. We describe the Alternative Pre-Hospital Pathway service, delivered by an EMT and an Emergency Medicine SpR responding to low acuity calls. This service achieved a 68% non-conveyance rate; our data demonstrates that a community emergency medicine outreach team in collaboration with the National Ambulance Service offering Alternative Pre-Hospital Pathways is an effective model for reducing conveyances to hospital.
4 citations