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A scoping study and qualitative assessment of care planning and case management in community paramedicine
DOI: http://dx.doi.org/10.32378/ijp.v3i1.76
Abstract
Introduction: Community paramedicine (CP) establishes an ongoing patient relationship beyond short emergency care episodes. How care planning and case management have been adapted from the isolated incidents of traditional practice is unclear. The objective of this study is to contribute to paramedic practice by examining broad areas of care planning in CP, identifying gaps in the evidence, clarifying key concepts, and reporting on the types of evidence that address and inform practice. A qualitative analysis of included literature outlines program capacities and identifies comprehensive models of care that can inform clinical practice in CP.
Methods: A scoping study was completed that included conducting a systematic search of the literature (in MEDLINE and CINAHL) and selecting relevant studies, followed by data extraction, summarizing, and reporting. The authors of included studies were contacted to confirm the aspects of care planning that were extracted from their respective studies. Aspects of care planning were compared between studies and used to generate a comprehensive list of existing practices.
Results: Ten of 1648 studies met inclusion criteria. Qualitative analysis identified 22 aspects of care planning along four themes; enrollment (n=3), assessment and management (n=6), intervention and care (n=5), and collaboration (n=8). No study included all 22 aspects of care planning. One aspect of care planning was present in all 10 studies; collaboration with primary care providers.
Conclusion: The aspects of care planning identified through this study provide a framework that can guide service providers in the delivery of care and researchers in defined outcome measures to be assessed. Future program development should be guided by the finding that all articles included in this study included collaboration with primary care providers. By summarizing care planning within CP programs, ongoing program development can embrace collaboration with other care providers to help insure that patients receive the appropriate care.
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References
Shah MN. The formation of the emergency medical services system. Am J Public Health. 2006;96(3):414-23.
Brennan J, Krohmer J. Principles of EMS systems. Jones & Bartlett Learning; 2006.
Cone DC, Middleton PM, Marashi Pour S. Analysis and impact of delays in ambulance to emergency department handovers. EMA - Emerg Med Australas. 2012;24(5):525-33.
Yong G, Dent AW, Weiland TJ. Handover from paramedics: Observations and emergency department clinician perceptions. EMA - Emerg Med Australas. 2008;20(2):149-55.
McCusker J, Ionescu-Ittu R, Ciampi A, Vadeboncoeur A, Roberge D, Larouche D, et al. Hospital Characteristics and Emergency Department Care of Older Patients Are Associated with Return Visits. Acad Emerg Med. 2007;14(5):426-33.
Aminzadeh F, Dalziel WB. Older adults in the emergency department: A systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med. 2002;39(3):238-47.
Schull MJ, Kiss A, Szalai JP. The Effect of Low-Complexity Patients on Emergency Department Waiting Times. Ann Emerg Med. 2007;49(3).
McHale P, Wood S, Hughes K, Bellis MA, Demnitz U, Wyke S. Who uses emergency departments inappropriately and when - a national cross-sectional study using a monitoring data system. BMC Med [Internet]. 2013 Dec 13 [cited 2017 Feb 24];11(1):258. Available from: http://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-258
Brydges M, Denton M, Agarwal G. The CHAP-EMS health promotion program : a qualitative study on participants ' views of the role of paramedics. BMC Health Serv Res [Internet]. 2016;1-9. Available from: http://dx.doi.org/10.1186/s12913-016-1687-9
Martin A, O'Meara P, Farmer J. Consumer perspectives of a community paramedicine program in rural Ontario. Aust J Rural Health. 2016;24:278-83.
Wingrove G. International Roundtable on Community Paramedicine. J Emerg Prim Heal Care. 2011;9(1):9-11.
Mason S, Wardrope J, Perrin J, Street R. Developing a community paramedic practitioner intermediate care support scheme for older people with minor conditions. Emerg Med J. 2003;20(2):196-8.
Choi BY, Blumberg C, Williams K. Mobile Integrated Health Care and Community Paramedicine : An Emerging Emergency Medical Services Concept. Ann Emerg Med [Internet]. 2016;67(3):361-6. Available from: http://dx.doi.org/10.1016/j.annemergmed.2015.06.005
Bigham BL, Kennedy SM, Drennan I, Morrison LJ. Expanding Paramedic Scope of Practice in the Community: A Systematic Review of the Literature. Prehospital Emerg Care. 2013;17(3):361-72.
O'Meara P. Community paramedics : a scoping review of their emergence and potential impact. Int Paramed Pract. 2014;4(1):5-12.
Jensen JL, Carter AJE, Rose J, Visintini S, Bourdon E, Brown R, et al. Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes. Can J Emerg Med. 2015;17(5):532-50.
Patterson DG, Coulthard C, Garberson LA, Wingrove G, Larson EH. What Is the Potential of Community Paramedicine to Fill Rural Health Care Gaps? J Health Care Poor Underserved [Internet]. 2016 [cited 2016 Nov 10];27(4A):144-58. Available from: https://muse.jhu.edu/article/634884
Woollard M. The Role of the Paramedic Practitioner in the UK. J Emerg Prim Heal Care. 2006;4(1).
O'Meara P, Tourle V, Stirling C, Walker J, Pedler D. Extending the paramedic role in rural Australia : a story of flexibility and innovation. Rural Remote Health. 2012;12.
O'Keeffe C, Mason S, Knowles E. Patient experiences of an extended role in healthcare : comparing emergency care practitioners ( ECPs ) with usual providers in different emergency and urgent care settings. Emerg Med J. 2014;31:673-4.
Swain AH, Al-salami M, Hoyle SR, Larsen PD. Patient satisfaction and outcome using emergency care practitioners in New Zealand. EMA - Emerg Med Australas. 2012;24:175-80.
Tohira H, Williams T a, Jacobs I, Bremner A, Finn J. The impact of new prehospital practitioners on ambulance transportation to the emergency department: a systematic review and meta-analysis. Emerg Med J [Internet]. 2013;1-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24243486
Squires JP, Mason S. Developing alternative ambulance response schemes: analysis of attitudes, barriers, and change. Emerg Med J [Internet]. 2004 Nov [cited 2016 Dec 28];21(6):724-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15496710
Mason S, Coleman P, Keeffe CO, Ratcliffe J, Nicholl J. The evolution of the emergency care practitioner role in England: experiences and impact. Emerg Med J. 2006;23:435-9.
Hoyle S, Swain AH, Fake P, Larsen PD. Introduction of an extended care paramedic model in New Zealand. EMA - Emerg Med Australas. 2012;24:652-6.
Swain AH, Hoyle SR, Long AW. The changing face of prehospital care in New Zealand: the role of extended care paramedics. J New Zeal Med Assoc NZMJ [Internet]. 2010;19(123):11-4. Available from: http://www.nzma.org.nz/journal/123-1309/3985/
Martin-Misener R, Downe-Wamboldt B, Cain E, Girouard M. Cost effectiveness and outcomes of a nurse practitioner-paramedic-family physician model of care: the Long and Brier Islands study. Prim Health Care Res Dev. 2009;10(1):14.
O'Meara P, Stirling C, Ruest M, Martin A. Community paramedicine model of care: an observational, ethnographic case study. BMC Health Serv Res [Internet]. 2015 Dec 2 [cited 2016 Oct 26];16(1):39. Available from: http://www.biomedcentral.com/1472-6963/16/39
Evans R, McGovern R, Birch J, Newbury-Birch D. Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedic system? A systematic review of the literature. Emerg Med J [Internet]. 2013 Apr 10 [cited 2016 Sep 19];594-603. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23576227
Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol [Internet]. 2005;8(1):19-32. Available from: http://www.scopus.com/inward/record.url?eid=2-s2.0-14644388070&partnerID=tZOtx3y1
Abrashkin KA, Washko J, Zhang J, Poku A, Kim H, Smith KL. Providing Acute Care at Home : Community Paramedics Enhance an Advanced Illness Management Program - Preliminary Data. J Am Geriatr Soc [Internet]. 2016 Dec [cited 2016 Dec 28];64(12):2572-6. Available from: http://doi.wiley.com/10.1111/jgs.14484
Agarwal G, Mcdonough B, Angeles R, Pirrie M, Marzanek F, Mcleod B, et al. Rationale and methods of a multicentre randomised controlled trial of the effectiveness of a Community Health Assessment Programme with Emergency Medical Services (CHAP-EMS) implemented on residents aged 55 years and older in subsidised seniors' housing b. BMJ Open [Internet]. 2015;5(6):e008110-e008110. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4466604&tool=pmcentrez&rendertype=abstract
Crockett BM, Jasiak KD, Walroth TA, Degenkolb KE, Stevens AC, Jung CM. Pharmacist Involvement in a Community Paramedicine Team. J Pharm Pract [Internet]. 2016 Mar 21 [cited 2016 Dec 28]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/27000138
Drennan IR, Dainty KN, Hoogeveen P, Atzema CL, Barrette N, Hawker G. Expanding Paramedicine in the Community ( EPIC ): study protocol for a randomized controlled trial. Trials [Internet]. 2014;15(473):1-10. Available from: http://www.trialsjournal.com/content/15/1/473
Heinelt M, Drennan IR, Kim J, Lucas S, Grant K, Spearen C, et al. Prehospital Identification of Underlying Coronary Artery Disease by Community Paramedics. 2015;3127(November 2016).
Edwards MJ, Bassett G, Sinden L, Fothergill RT. Frequent callers to the ambulance service: patient profiling and impact of case management on patient utilisation of the ambulance service. Emerg Med J [Internet]. 2014;32:1-5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25312857
Jensen JL, Marshall EG, Carter AJE, Boudreau M, Burge F, Travers AH. Impact of a Novel Collaborative Long-Term Care-EMS Model: A Before-and-After Cohort Analysis of an Extended Care Paramedic Program. Prehospital Emerg Care. 2016;20(1):111-6.
Marshall EG, Clarke B, Peddle S, Jensen J. Care by Design: New model of coordinated on-site primary and acute care in long-term care facilities. Can Fam Physician [Internet]. 2015;61(3):129-34. Available from: http://www.cfp.ca/content/61/3/e129.short
Jensen JL, Travers AH, Bardua DJ, Dobson T, Cox B, Mcvey J, et al. Transport outcomes and dispatch determinants in a paramedic long-term care program : a pilot study. Can J Emerg Med. 2013;15(4):206-13.
Jensen JL, Travers AH, Emily G, Cain E, Leadlay S, Alix JE. Insights into the Implementation and Operation of a Novel Paramedic Long-term Care Program. Prehospital Emerg Care. 2014;18(1):86-91.
Mason S, Knowles E, Colwell B, Dixon S, Wardrope J, Gorringe R, et al. Effectiveness of paramedic practitioners in attending 999 calls from elderly people in the community: cluster randomised controlled trial. BMJ. 2007;335(7626):1-6.
Mason S, Knowles E, Freeman J, Snooks H. Safety of Paramedics with Extended Skills. Soc Acad Emerg Med. 2008;15(7):607-12.
Dixon S, Mason S, Knowles E, Colwell B, Wardrope J, Snooks H, et al. Is it cost effective to introduce paramedic practitioners for older people to the ambulance service? Results of a cluster randomised controlled trial. Emerg Med J [Internet]. 2009;26(6):446-51. Available from: http://emj.bmj.com/content/26/6/446.abstract
Knowles E, Mason S, Colwell B. An initiative to provide emergency healthcare for older people in the community : the impact on carers. Emerg Med J. 2011;28:316-20.
Mason S, O'Keeffe C, Knowles E, Bradburn M, Campbell M, Coleman P, et al. A pragmatic quasi-experimental multi-site community intervention trial evaluating the impact of Emergency Care Practitioners in different UK health settings on patient pathways ( NEECaP Trial ). Emerg Med J [Internet]. 2012 Jan [cited 2016 Sep 23];29(1):47-54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22186262
O'Keeffe C, Mason S, Bradburn M, Iheozor-Ejiofor Z. A community intervention trial to evaluate emergency care practitioners in the management of children. Arch Dis Child [Internet]. 2011 Jul [cited 2016 Dec 28];96(7):658-63. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21505224
Ruest M, Stitchman A, Day C. Evaluating the impact on 911 calls by an in-home programme with a multidisciplinary team. Int Paramed Pract. 2012;1(4):125-32.
O'Meara P, Ruest M, Martin A. Integrating a Community Paramedicine program with local health, aged care and social services: An observational ethnographic study. Australas J Paramed [Internet]. 2015;12(5). Available from: http://ajp.paramedics.org/index.php/ajp/article/view/238
Community Paramedicine: Framework for program development. Toronto, ON: CSA Group; 2017.
DOI: http://dx.doi.org/10.32378/ijp.v3i1.76
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