Reducing Emergency Department (ED) wait times and improving community health initiatives are major priorities in Canada. Three of the most common chronic diseases worldwide are diabetes, congestive heart failure, and chronic obstructive pulmonary disease.
These diseases are on the rise and currently cost the Canadian healthcare system billions of dollars every year including the cost of hospitalizations and emergency department visits. The existing healthcare system does not have the resources and manpower to effectively care for these patients in the future.
As a result, St Michael’s Hospital in Toronto is sponsoring a clinical trial listed in clinicaltrials.gov http://clinicaltrials.gov that will use paramedics effectively to provide emergency medical services in remote, rural, and urban settings in Canada.
Currently, paramedics as highly trained healthcare practitioners are connected and mobile in the community. They currently work with physicians that regularly rely on their independent judgment giving them a significant advantage in assessing patients.
Increased community paramedic care could decrease the utilization of the healthcare system resources for patients with chronic disease. By using a randomized control trial design, the study is going to attempt to answer the question on whether non-emergency community paramedics would be able to conduct home visits that would undertake assessments and evidence-based treatments of patients in partnership with family doctors to decrease the rate of patient hospitalizations.
One group in the study will continue to receive the usual care from their family healthcare team. This care includes physician assessment and treatment and periodic augmentation of care in the community at the discretion of the treating physician.
The other study group will enable patients to have an initial visit and three follow-up visits at three month intervals over one year by a paramedic. The paramedic will have received additional training in chronic disease management and can provide routine care plus provide any additional visits requested by the patient or the family healthcare team.
For more information on the clinical trial, go to http://clinicaltrials.gov/ct2/show/NCT02034045. Email the Principal Investigator Laurie Morrison Md. at St. Michaels at morrison@smh.ca or call 416-864-6060 extension 7849.
Another program utilizing a team to make house calls to reduce unnecessary emergency room visits and hospital stays, uses the expertise of teams comprised of a paramedics, critical care nurses, and EMTs to make house calls on heart patients soon after their discharged from The Valley Hospital www.valleyhealth.com in Ridgewood N.J. The “Mobile Integrated Healthcare Program”, complements the hospital’s home care comprehensive roster of services.
The program launched in 2014, targets patients with cardiopulmonary disease at high risk for hospital readmission who either decline or do not qualify for home care services. The team provides a full assessment, including a physical exam, a safety survey of the patient’s home, medication education, reinforcement of discharge instructions, and confirmation that the patient has made an appointment for a follow-up visit with their physician
The program has recently been expanded to include patients who have undergone the transcatheter aortic valve replacement (TAVR) procedure, a minimally invasive treatment option for patients with severe, symptomatic aortic valve stenosis where traditional valve replacement surgery is not an option.