Reshaping healthcare delivery for elderly patients: the role of community paramedicine; a systematic review

Vuuren et al. BMC Health Services Research https://doi.org/10.1186/s12913-020-06037-0 (2021) 21:29 RESEARCH ARTICLE Open Access Reshaping healthcare delivery for elderly patients: the role of community paramedicine; a systematic review Julia van Vuuren1* , Brodie Thomas1, Gina Agarwal2,3, Sean MacDermott1, Leigh Kinsman4, Peter O’Meara5 and Evelien Spelten1 Abstract Background: Healthcare systems are overloaded and changing. In response to growing demands on the healthcare systems, new models of healthcare delivery are emerging. Community paramedicine is a novel approach in which paramedics use their knowledge and skills beyond emergency health response to contribute to preventative and rehabilitative health. In our systematic review, we aimed to identify evidence of the community paramedicine role in care delivery for elderly patients, with an additional focus on palliative care, and the possible impact of this role on the wider healthcare system. Methods: A systematic review of peer-reviewed literature from MEDLINE, Embase, CINAHL, and Web of Sciences was undertaken to identify relevant full-text articles in English published until October 3, 2019. Additional inclusion criteria were studies focussing on extended care paramedics or community paramedics caring for elderly patients. Case studies were excluded. All papers were screened by at least two authors and underwent a quality assessment, using the Joanna Briggs Institute appraisal checklists for cross sectional, qualitative, cohort, and randomised controlled trial studies to assess the methodological quality of the articles. A process of narrative synthesis was used to summarise the data. Results: Ten studies, across 13 articles, provided clear evidence that Community Paramedic programs had a positive impact on the health of patients and on the wider healthcare system. The role of a Community Paramedic was often a combination of four aspects: assessment, referral, education and communication. Limited evidence was available on the involvement of Community Paramedics in palliative and end-of-life care and in care delivery in residential aged care facilities. Observed challenges were a lack of additional training, and the need for proper integration and understanding of their role in the healthcare system. (Continued on next page) * Correspondence: The abstract of this paper was presented as a poster at the Australasian College of Paramedicine 2020 International Conference (ACPIC20): van Vuuren J, Thomas B, Agarwal G, O’Meara P, Spelten E. Reshaping healthcare delivery for elderly patients: the role of Community Paramedicine. A systematic review. Poster presented at: Australasian College of Paramedicine 2020 International Conference; 2020 October 21-23; Online. 1 Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Vuuren et al. BMC Health Services Research (2021) 21:29 Page 2 of 15 (Continued from previous page) Conclusions: The use of community paramedics in care delivery could be beneficial to both patients’ health and the wider healthcare system. They already play a promising role in improving the care of our elderly population. With consistent adherence to the training curriculum and effective integration within the wider healthcare system, community paramedics have the potential to take on specialised roles in residential aged care facilities and palliative and end-of-life care. Keywords: Community paramedicine, Emergency medical technicians, Palliative care, Nursing home, Elderly, Health services for the aged, Terminal care Background In response to growing demands on the healthcare systems, new models of healthcare delivery are emerging [1–4]. The healthcare workforce, jurisdictional authorities and healthcare organisations are becoming more differentiated and embracing inter-professional collaboration and task substitution. This growing international trend in healthcare policy refers to a shift away from historical workforce hierarchies, and to allocating roles based on professional accomplishment [1, 4]. One of the areas currently undergoing rapid and significant change is delivery of care to elderly adults [2, 3]. It has been well established that the world’s population is ageing [5]. Elderly adults experience more illnesses which are often chronic conditions, such as cancer, or cardiovascular diseases [6]. They typically have multiple diseases (such as dementia, osteoporosis and arthritis) and the severity score of comorbidity increases with age [7, 8], requiring more complex and specialised care. Therefore, the already high demand on palliative care (PC), end-of-life care (EOL) (together: PEOL), and (specialised) aged care is likely to increase in the near future [8]. This increased demand will occur alongside a predicted healthcare workforce shortage. This is likely to prove particularly challenging for Residential Aged Care Facilities (RACFs), where the number of visiting physicians is forecast to decrease [2]. Elderly adults residing in RACFs are a complex and vulnerable population, with high levels of frailty, functional impairment, and comorbidities including cognitive impairment [9]. The number of people in residential aged care is increasing in Western countries and there are concerns about the care provided. Harrington et al. found that in their study standards and levels of care in most countries do not meet levels recommended by experts [10]. In Australia, aged care services admissions increased by 42% in 2017–18 [11] and the current Royal Commission into Aged Care has concluded that aged care is failing to meet basic community expectations and quality of care [12]. Some of the issues highlighted include patchy and fragmented palliative care and difficulties in recruiting and retaining adequately skilled s (...truncated)