Presentación

Nouvel, Jea

De Amate-geesten van San Pablito

Wetensch. publicatieFaculty of Archeolog

Indicators of paramedic service use by community dwelling older adults

Introduction:  Home care clients represent a patient group that may be served through community paramedicine (CP) programs.  The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale was recently validated to identify levels of risk for use of emergency care among this population.  This study investigates whether frail home care clients that were identified as being at higher risk based on their DIVERT scores were more likely to use paramedic services to access the emergency department within 90 days of assessment when compared to clients that had lower DIVERT scores.Methods: A retrospective cohort study was conducted using regularly collected administrative data.  Home care assessment data were supplemented with data on emergency department (ED) visits.  Arrival by ambulance was modelled to control for DIVERT scores as well as several social and demographic variables.Results:  Within the cohort, approximately 40% of individuals visited an ED within 90 days of a home care assessment and almost half of all individuals visited an ED more than once within a year.  About two-thirds of clients that visited an ED in the 90 days following assessment used an ambulance for transportation.  DIVERT scores were predictive of this use with highest scores indicating 4.15 times higher odds of paramedic service use (95% CI 3.60-4.78Conclusion:  DIVERT was not developed to consider means of transportation to the ED.  The results indicate that it can be used to identify frail community dwelling older adults that are likely to use paramedic services to take them to the ED.  Further investigation of aspects of social isolation, carer resiliency, time of use, and characteristics associated with ED discharge are warranted.  Frequent ambulance use among this population suggests that collaboration between care providers may provide opportunities to prevent unnecessary ED visits by these individuals

A scoping study and qualitative assessment of care planning and case management in community paramedicine

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

A scoping study and qualitative assessment of care planning and case management in community paramedicine

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