Paramedicine is a hybrid practice of emergency and primary care medicine, and it’s rapidly gaining attention nationwide. Providers are specially trained emergency medical technicians and paramedics who periodically rotate off their usual duty to attend to chronically ill patients in their homes.
Patients can be frequent 911 callers (15 or more calls within 90 days) or have a history of 30-day readmissions to the hospital with the likelihood of more, says Sean Burton, clinical programs manager for private EMS provider MedStar Mobile Healthcare in Fort Worth, Texas.
In the case of frequent 911 callers, MedStar asks them if they’d like to enroll in the community paramedicine program to help them navigate the healthcare system, he says. Or, MedStar gets referrals from cardiologists, case managers, hospice agencies or other community facilities.
Patient education is key
“We’ll go out and do a home evaluation to see what needs aren’t being met,” Burton says. “There’s a great deal of patient education about their disease process and management of it.”
That can include finding out why they call 911 so frequently and what they need that isn’t available, such as a consistent way to get prescriptions filled.
That feedback is shared with patients’ primary care providers, cardiologists or other caregivers, and helps develop the patient-provider relationship to avoid visits to the hospital ER.
And that cuts healthcare costs, too.
According to a Medstar case study (included in a July 2013 report on paramedicine by the University of California-Davis Institute for Population Health Improvement), 21 patients who had been taken to the ER more than 800 times within 12 months incurred costs of almost $1 million in ambulance charges alone before the paramedicine program was put in place.
After congestive heart failure patients were enrolled in two different programs, cost savings ranged from $16,000 to $39,000 per patient, according to the UC study. And readmissions and ambulance trips dropped dramatically.
Special training needed
So far, there’s no certification program for paramedicine providers. But Burton recommends special training. At MedStar, the curriculum focuses on a detailed patient assessment that includes social aspects and an evaluation of the patient’s home environment. Providers also help identify community resources and how the patient can access them. Training can include spending time at cardiology clinics or accompanying a hospice nurse on patient visits, too.
If this type of program resonates with you or your local EMS providers, one of the first things to do is determine the needs of your community, Burton says. One community’s needs aren’t the same as the next one’s. And then determine if you have the materials and services to meet those needs.
“This is not about denying people access to the ER but navigating them to a more appropriate resource,” Burton says. “If the ER is the right place for them, that’s where we send them.”
Find out more about community paramedicine at the National Association of Emergency Medical Technicians website.
© Health Callings, Dice Holdings Inc., 2013
