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Someone to watch over me

In rural and remote B.C. communities—many with high rates of chronic disease—paramedics are helping prevent emergencies before they happen.

Chris Michel’s job has changed dramatically over the last three years. A longtime paramedic, Michel recently became a community paramedic (CP) and is now also a mentor to other CPs.

While his colleagues responded to most emergency calls around Boston Bar, a small town on the steep side of the Fraser Canyon, Michel is focused on helping the area’s 1,000 residents stay healthy—and avoid having to call 911.

“My daily work as a CP was about promoting health,” says Michel. “I visited and monitored at-risk patients. I held health seminars and disease-specific workshops. I helped people learn more about their conditions and how to self-manage their health. Community Paramedicine is fascinating, rewarding work.”

And it’s making a big difference in this community 200 km northeast of Vancouver, where the prevalence of COPD is twice the provincial average , 67 per cent of the population lives on less than $40,000, and the nearest health centre is up to 80 km away on a twisting and dangerous highway: all risks to health.

Better health access in smaller places

Michel is part of the Community Paramedicine program created by B.C. Emergency Health Services (BCEHS) in 2015. The program places paramedics in 99 rural and remote places, which tend to be underserved by healthcare.

“CPs are problem solvers,” says Nancy Kotani, Chief of Transformation and Strategy at BCEHS. “Their role is proactive—building relationships and trust with patients, providers and the community as whole. It’s a completely new paradigm.”

Daily connections with patients

Supporting CPs in their quest to improve the overall health of their community is Home Health Monitoring (HHM) technology. HHM lets patients track their health at home while care teams monitor daily—and intervene if biometrics or self-evaluations move out of a healthy range.

Patients are provided with easy-to-use software and hardware (tablet, BP monitor, pulse oximeter, weight scale) that connect wirelessly via Bluetooth technology and a cellular network to provide monitoring clinicians with daily biometric and non-biometric patient responses to the monitoring interviews.

CPs in B.C. are focused on patients with five conditions: COPD, diabetes, heart failure, risk of falls, and palliative. Clinicians in Fraser Canyon Hospital, the area’s nearest medical centre 45 minutes away in Hope, could not be more pleased.

Site Medical Director Dr. Josh Greggain: ““Chris and the CP program have made an unbelievable difference for a handful of isolated and medically complex patients.”

Patients help themselves

Self-monitoring symptoms and vitals every day has a lot of upside. Patients can catch impending problems—say, a COPD flare-up—and act on their care plan, which might be as simple as taking prednisone.

“Fast treatment like that can help prevent deterioration, ambulance calls, hospitalizations,” said Dr. Greggain. “Our patients are getting better care with the proactive CP model than with reactive care from us.”

Changing behaviour and opening communication

Besides earlier interventions, another long-term plus is the learning and behaviour changes that result from HHM.

Michel: “Over time, patients get to know what good pulse oximetry is, what blood pressure levels to aim for, what weight to maintain. They understand their condition at a deeper level, and get to know what’s normal—and what’s not. And the comfort patients feel when they know someone’s looking out for them is absolutely huge.”

Michel and Greggain agree that relationships are unbelievably important to health. “Chris and his patients got along well and enjoyed each other’s company,” said Greggain.

“Through relationships we build trust,” said Michel. “And when patients can trust you, they will open up about what’s really bothering them instead of being scared of what their symptoms could mean. And that’s when we can really help them.”

Easy tech for the non-techie

How are patients at home coping with using the new technology?

“Many of the patients are elderly and have never used technology before,” says Michel. “You can imagine how intimidating it is for them to sit down with the tablet, devices and HHM application—they worry they might break it. But they quickly find that it’s very straightforward to use.”

“And our provider portal is equally easy to use.”

Serving the underserved

The use of HHM to help vulnerable and underserved patients will only grow as both the community paramedicine program and the core HHM program roll out across the province. Dr. Greggain wants to see this program expand into even more communities than the initial 99.

More on CPHHM

Community Paramedicine’s Home Health Monitoring (CPHHM) service is part of a provincial program of HHM offerings led by the BC Ministry of Health, BC’s Health Authorities, and TELUS Health.

Today, most of the 100+ CPs working in BC are able to augment their wellness check services for individuals with clinically-developed, HHM monitoring interviews for patients living with heart failure, COPD, diabetes and (soon to be) supportive/palliative care. 

For more information on the Community Paramedicine Program, please reach out to BC Emergency Health Services Project Manager for Strategic & Process Initiatives:   Boston Ba CP Chris Michel.

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