The emergence of Community Paramedicine (CP) in Ontario has challenged Paramedic Services to change the way they think about supporting individuals in the community. Community Paramedicine shifts the focus of service delivery from being traditionally reactive, to preventative and supportive. Although approaches to supporting patients through Community Paramedicine vary from service to service, all programs benefit from partnerships with local community and healthcare service providers.
Partnerships are the foundation of a successful CP program, and a key element of program sustainability. Community Paramedicine works in partnership with local services and programs that can enhance the level of support clients receive. Whether it’s referral destinations for patients identified on 911 calls, or in the capacity of providing in home support through home visit programs, Paramedic Services alone cannot support all patient needs. Understanding that there is much more than physical health itself that contributes to the overall health of an individual, partnerships should include homecare agencies, social services and healthcare sectors to provide a well-rounded CP program.
Community Paramedicine in Simcoe County
Initiated in 2015, the County of Simcoe built its Community Paramedicine program using a one-time funding opportunity from the Ministry of Health. Paramedic Services focused on a phased approach to launching programs that meet local needs of the communities within Simcoe County. With the uncertainty about ongoing funding, it was important to develop programs that could be sustained should funding remain limited.
In 2015, the County launched its first Paramedic Referral pathway targeting patient needs identified by paramedics on 911 calls. The program initially consisted of a single referral destination to Home and Community Care (formerly known as the Community Care Access Centre) to link patients with traditional home care services. It was quickly determined that patient needs extended beyond the capability of homecare services, prompting the addition of new partnerships with both healthcare and community support agencies. The program found success in collaborating with social and community services agencies. This allows patients to benefit from a more global approach to their needs, as opposed to focusing on physical health alone. Patients benefit from a new partnership between Paramedic Services and 211 Ontario, providing system navigation and additional service referrals for patients in real time, 24/7.
To date, over 5,000 referrals have been received from front line paramedics who have advocated for their patients to receive additional support. Over 60 per cent of the referrals submitted by paramedics resulted in the patient receiving new or increased services and/or resources. An analysis of Paramedic Services utilization was performed in 2019 for 1,133 referral patients that had been connected with new or increased services. A 30 per cent decrease (956 calls) in Paramedic Services 911 calls was observed in the six (6) months after the referral, compared to the six months prior. Reducing 911 call requests for Paramedic Services improves overall system capacity. Increased availability of paramedics reduces the rate at which the service must grow to meet the increasing needs of the growing seniors population. Furthermore, reduced 911 calls reduces the impact on emergency departments and offload delay creating a multiplier effect for the service and hospital. This enhances capacity, reducing wait times and hallway medicine.
Launched in 2016, the County of Simcoe’s Home Visit Program provides at-home chronic disease management for clients in partnership with their own primary care Physician or Nurse Practitioner. A unique partnership with the Couchiching Family Health Team established this program, which has supported 200 chronic disease patients since it began. Paramedics work with primary care to focus on keeping patients safe at home, where they want to be. The program started in three of the eighteen lower tier municipalities/separated cities within Simcoe County. With initial program success, expansion is underway to spread this program across the entire county.
The Home Visit Program uses Rapid Response Units staffed with Community Paramedics deployed in rural communities that have the primary role of responding to high priority 911 calls. Understanding that the Simcoe County Community Paramedic Rapid Response Units are deployed in areas that have low call volumes, time between calls is spent performing routine visits and exacerbation response for enrolled CP clients. This ‘hybrid model’ increases value to paramedic deployment in rural areas of the County.
In 2018, Community Paramedics attended to 104 exacerbation calls from rostered chronic disease patients. 76 per cent of the time, these patients remained at home following an assessment, with or without treatment from the Community Paramedics. In 2019, 205 exacerbation responses occurred, with 87 per cent of the occurrences preventing a 911 call and subsequent transport to the emergency department. In addition to the avoidances of 911 calls and ED visits, a 13 per cent reduction in primary care visits was observed in a 6-month pre/post analysis performed in 2017.
Frequent Caller Follow Up
Beginning in November 2018, County of Simcoe Paramedic Services began piloting Frequent Caller Follow-up in partnership with McMaster University’s CP@Home program. Frequent callers are identified by repeat 911 use for Paramedic Services. Paramedics perform home visits providing a more hands on approach to assessment and referral.
Frequent Caller Follow-up is built on the success of McMaster University’s CP@Clinic (formerly CHAP-EMS) randomized control trial that showed a 19 per cent relative reduction in total 911 use in the buildings where wellness clinics were offered. The County of Simcoe’s clinic program ran from 2015 through to 2016 in two sites across the county.
The early success of Community Paramedicine in Simcoe County has highlighted the benefits the program presents to patients, Paramedic Services, and the healthcare system as a whole. Community Paramedicine puts existing resources to work in the community, building greater capacity in the healthcare system at a time where we need it most.
For more information on Community Paramedicine in Simcoe County, please visit www.simcoe.ca/dpt/ps/paramedicine.
The Ontario Community Paramedicine Secretariat recognized Simcoe’s Community Paramedicine Program for their partnership with the Couchiching Family Health
Team (CFHT) and their Home Visit Program. Pictured from left to right: Kyle MacCallum; Julia McWilliam (Community Paramedic); and Lynne Davies (Executive Director, Couchiching Family Health Team).
Kyle MacCallum and Kristen Gilmartin, Clinical Programs Supervisor in front of our Community Paramedicine Unit.