Community Paramedicine: Bridging the Gap

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The community paramedic is a new resource designed to encourage appropriate and efficient healthcare utilization.
The community paramedic is a new resource designed to encourage appropriate and efficient healthcare utilization.
In recognition of 20 years of providing information designed to improve clinical practice, Clinical Advisor acknowledges the role of the community paramedic in promoting health care and optimizing patient outcomes.  

When a patient walks out of the clinic doors or leaves the emergency department (ED), their care doesn't stop there. Follow-up appointments are scheduled, referrals to specialists have been made, and medications are often prescribed. It is uncertain, however, if the patient will make it to those appointments. Do they have resources for travel, and if so, are they going to remember the appointment? Will a minor condition or exacerbation cause them a return visit to the ED? Are they taking the medications as prescribed? These are questions that practitioners often don't get the answers to unless patients make it back for that follow-up appointment, or they may never get the answers at all. These problems often create a healthcare gap for patients, which lead to a decrease in care efficacy.

The community paramedic model includes our emergency medical service colleagues providing a new usable tool to bridge this healthcare gap. The idea of the community paramedic is still in its infancy, meaning many providers are unsure what a community paramedic is.

Community paramedics are first trained within the standard paramedic education model. Then, licensed paramedics can go through further program-dependent training to work as a community paramedic. California, for example, has developed a statewide curriculum that is contracted with the UCLA Center for Prehospital Care. The pilot program curriculum, including both lecture and clinical components, will then be taught at various other sites. Topics include chronic management of heart failure, proper medication management, and heart-healthy diet organization. Effective implementation works toward the goal of decreasing unnecessary hospital readmissions and improving overall care.1

To properly utilize the community paramedic, it is important to understand their role. Across the country, the scope of practice of the community paramedic varies based upon local medical direction. According to a report on the community paramedicine model of care by Kizer et al,2, community paramedics can transport patients to facilities outside the ED when appropriate; determine if a patient needs transport to an ED after proper prehospital treatment; tailor care to frequent users of the 911 system in the form of primary care and social services; provide and facilitate proper follow-up care for discharged patients; provide support for patients with chronic conditions such as diabetes, asthma, and heart failure; and partner with primary care providers to deliver preventive care in underserved urban and rural areas. This facilitation of care is used to guide patients to the most effective method of healthcare given their current condition.

Community paramedics are also able to assist healthcare providers in both the primary care and emergency medicine specialties. In primary care, providers see patients during all 3 of the phases of care in which community paramedics can successfully be utilized. A patient with heart failure is one example that commonly needs care in all 3 facets: preventive care including medication and diet management, the actual heart failure exacerbation event, and then post-event care in the form of discharge care facilitation. Community paramedic assistance helps ED providers ensure proper follow-up care is obtained, while also decreasing repeat ED visits due to poor follow-up compliance.

MedStar, a not-for-profit agency out of Dallas, Texas, is an example of a new program enjoying success. They saw an opportunity to work with their local hospital systems to decrease ED visits and improve overall care. At the time the program was started, 21 frequent users of the 911 system equated 2100 ambulance hours and approximately $150,000 in healthcare expense the previous year. Identifying and targeting those patients with the new community paramedic program cut patients' usage by 57%. This also evolved into chronic care management by the community paramedic between healthcare visits, creating better follow-up compliance and overall efficacy.3

MedStar is only one example, but as the community paramedic model continues to grow, providers across the nation will be able to turn to these programs to improve overall patient care. Community paramedics provide vital services in the form of preventive care in underserved areas, triage of acute calls, and facilitation of follow-up care, as necessary. Community paramedic utilization provides one more tool to help bridge the healthcare gap and answer those often unanswered questions. 

Cody Hoff, PA-C,  graduated from Drexel University with a Masters of Health Sciences - Physician Assistant degree and is now NCCPA certified and working in family practice and emergency medicine for Deckerville Community Hospital in Michigan. He is also licensed as an EMT-B and previously worked in pre-hospital medicine, which sparked his interest in the community paramedic model during his schooling.

References

  1. Erich J. (2014, September 4). Community paramedic curriculum.  EMSWorld.com. August 4, 2014. Available at: http://www.emsworld.com/article/11610552/community-paramedic-curriculum. Accessed September 17, 2018.
  2. Kizer K, Moulin A, Shore K. Community paramedicine: a promising model for integrating emergency and primary care. August 1, 2012. Available at: http://www.naemt.org/Files/MobileIntegratedHC/UC%20Davis%20Community%20Paramedicine%20Report.pdf.  Accessed September 17, 2018.
  3. Berry J. Community Health Programs Create New Niche for EMS. July 25, 2012. Available at: https://www.jems.com/articles/print/volume-37/issue-8/2020vision/community-health-programs-create-new-nic.html. Accessed September 17, 2018.
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