Community Paramedicine at Home

NCT02835989 | Completed

• 1 other identifier: 2153
• Study Type: interventional
• Target: 2,826
• Locations: 1 country
• Sites: 1

Brief Summary

Community Paramedicine @Home (CP@Home) is a novel community paramedicine health assessment program for high users of Emergency Medical Services (EMS). Individuals who have been identified as active callers to EMS, individuals who have called EMS for lift-assists, and direct paramedic referrals are referred into the community paramedicine home visit program. The program will focus on in-home chronic disease management, community health service connections, and EMS usage education. Aside from chronic disease management, aspects of the program include health-related quality of life, social isolation and other social determinants of health. Participants in the program will have up to 3 one-on-one home visits from a community paramedic to ultimately reduce repeat EMS calls and improve their overall health.

Conditions

Cardiovascular Disease; Diabetes Mellitus; Accidental Falls; Social Isolation; Food Insecurity

Keywords

Community Paramedicine; Paramedic; Emergency Medical Services; High Frequency Callers; Lift Assists

Outcome Measures

Primary Outcomes (1)

• Change in number of repeat EMS calls

  Individual-level change in EMS call rate resulting in ambulance dispatch (pre-post intervention)

  Baseline and 1 year

Secondary Outcomes (2)

• Change in number of ED presentations

  Baseline and 1 year

• Change in number of hospital admissions

  Baseline and 1 year

Study Arms (2)

CP@Home Intervention

EXPERIMENTAL

The experimental group will receive the CP@Home program. The main elements of this program include BP assessment, diabetes risk assessment, falls risk assessment, heart failure risk assessment, neurologic assessment, psychiatric assessment, depression screening, health-related quality of life analysis (including pain, mobility, anxiety/depression, ADLs), social isolation screening, and food and income security. The program is targeted at referrals to appropriate community resources, identification and referral of high-risk patients to their family physician (FP), as well as regular communication of participants' health information to their physician. The intervention will be implemented by community paramedics from the local paramedic service who have undergone a structured training program (4 hours of online, interactive training modules, including case studies and the observation of an intervention visits led by another paramedic) to assure intervention fidelity.

Other: CP@Home

Control

NO INTERVENTION

Usual Care

Interventions

CP@Home OTHER

Community paramedics (CPs) will be assigned to visiting the participants for a first time the week following the initial EMS call. Participants will complete the informed consent process with a CP on their first visit. This visit will also include a full assessment and risk analysis that will take approximately 90 minutes and will be located in the participant's home. As a result of the initial visit, the CP will make all relevant clinical referrals and decisions based on predetermined @Home algorithms. A second visit will be made to the participant 2-4 weeks following the initial call for a streamlined follow-up and reassessment during a 30 minute period. A final visit will be made 6-8 weeks following the initial call for a final evaluation of their situation. It is anticipated the patient will be discharged from the CP@Home program at this point. If the patient calls EMS following the third visit, if they meet the inclusion criteria, they will be re-entered into the CP@Home program.

CP@Home Intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• or more EMS calls in the last 6 months from intervention start date AND active caller in the last 30 days OR
• Any call for a lift assist to EMS in the past 30 days OR
• Paramedic referral into program (identified by paramedic through usual practice)

You may not qualify if:

• Individuals living in long term care facilities
• Individuals currently involved in a home visit or social navigator program

Sponsors & Collaborators

• McMaster University: lead

Study Sites (1)

McMaster University

Hamilton, Ontario, L8S4K1, Canada

Location

Related Publications (2)

• Agarwal G, Angeles R, Brar J, Pirrie M, Marzanek F, McLeod B, Thabane L. Effectiveness of the community paramedicine at home (CP@home) program for frequent users of emergency medical services in Ontario: a randomized controlled trial. BMC Health Serv Res. 2024 Nov 25;24(1):1462. doi: 10.1186/s12913-024-11952-7.

  PMID: 39587610 DERIVED

• Agarwal G, Pirrie M, McLeod B, Angeles R, Tavares W, Marzanek F, Thabane L. Rationale and methods of an Evaluation of the Effectiveness of the Community Paramedicine at Home (CP@home) program for frequent users of emergency medical services in multiple Ontario regions: a study protocol for a randomized controlled trial. Trials. 2019 Jan 23;20(1):75. doi: 10.1186/s13063-018-3107-4.

  PMID: 30674347 DERIVED

MeSH Terms

Conditions

Cardiovascular Diseases; Diabetes Mellitus; Social Isolation

Condition Hierarchy (Ancestors)

Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases; Social Behavior; Behavior

Study Officials

• Gina Agarwal, MBBS MRCGP CCFP PhD

  McMaster University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: PREVENTION
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 14, 2016
• First Posted: July 18, 2016
• Study Start: October 25, 2018
• Primary Completion: July 20, 2020
• Study Completion: December 31, 2021
• Last Updated: September 22, 2022

Record last verified: 2022-09

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)