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Can paramedics fill the gaps in primary care for chronically ill patients? A team of researchers led by University of Toronto's Katie Dainty decided to find out.

The researchers evaluated a trial training program for community paramedics in York Region and Grey County, which had community paramedics visit the homes of chronically ill patients for physical assessments. The idea was for these patients to get help without visiting the emergency room.

Dainty, who is an assistant professor at the Institute of Health Policy, Management and Evaluation and research chair in patient outcomes at North York General Hospital, then studied the effectiveness of this program, and found that the trial program not only met the psychosocial needs of the patients, but also improved their health outcomes.

“Patients with chronic illnesses have an array of complex needs but they don’t always require hospital visits or emergency care,” said Dainty. “But there is often no other way for them to get the care they need, and they are forced to call 911.”

Most chronically ill patients surveyed did not want to end up in emergency rooms, where they can experience long wait times and end up exposed to illnesses that can complicate their own conditions further. Yet with the way the primary care system is structured, there is often little choice.

“That’s where the use of community paramedics can play a role in helping our health system to address this gap in accessible primary care,” said Dainty.

“These are highly trained individuals, who in rural areas often have a lot of down time between calls. If we can reallocate these resources in Ontario, we will be able to provide patients with better care solutions.”  

The qualitative study looked at not only whether the program was working, but also how it affected the health outcomes for these patients, many of whom suffered from a variety of complex care needs associated with congestive heart failure, diabetes, and other conditions.

Throughout the trial, paramedics would visit the homes of these patients every three months and using special equipment, would conduct complete physical assessments, all without the patient having to be transported out of the home.

“We found quickly that our focus as paramedics turned from being reactive to proactive,” said Scott Luce, a community paramedic for the county of Grey. “This makes all the difference in the world. It keeps our patients at home, where they want to be, and it also catches other health problems early on, such as second- and third-degree heart blocks. As a result, these patients have seen earlier treatment.”

Dainty’s study also revealed further benefits of this type of care. “We found that patients were developing a social relationship with these paramedics as they were helped through the rough patches of their illnesses,” she said.

The paramedics were often able to assess the entire home situation, speak with caregivers, spouses and children, and determine if the patient needed further assistance, such as with nutrition or home care. “That type of care isn’t something doctors in emergency rooms are able to provide,” said Dainty. 

Luce agrees.  “Patients love the program, primary care physicians respect it, and the community paramedics enjoy a level of satisfaction rarely seen in paramedicine. A rare case of win, win, win,” he said.