Community Paramedicine Models for Prevention and Health Education
Prevention and health education represent one significant role for community paramedics in the healthcare system. Through home visits, telehealth appointments, and telephone check-ins, community paramedics can identify medication errors, environmental risks, or problems with durable medical equipment that are not often identified in a traditional clinical or healthcare setting.
People with complex chronic conditions often have many prescriptions, each with their own dosing schedules, warnings, and instructions. This complexity can make it challenging for patients to take their medication safely and correctly each day. In addition, because these prescriptions often come from multiple providers, patients may not have support managing their medication lists. There may be contraindications, errors in dosage, drug type, or patient usage, resulting in adverse drug events that can be harmful or even fatal.
One important role for community paramedics is to help patients manage medications. Community paramedics can help set up reminders, explain dosing instructions, identify medication management issues like improper storage, and uncover errors in their medication list. Medication reconciliation has three steps:
- Verification: Developing a comprehensive list of all current prescriptions
- Clarification: Confirming medications and dosage are appropriate
- Reconciliation: Making necessary adjustments to the list to ensure no errors, duplications, or omissions
Community paramedics can work with patients and other healthcare providers to conduct all three steps of this process. Using the Medication Management Strategy from the Agency for Healthcare Research and Quality (AHRQ) or another method, community paramedics can help patients develop a comprehensive list of their current prescriptions.
Once the list is correct, the community paramedic confirms its contents with the patient's providers, ensuring that all dosages are correct and all medications are still currently needed to manage their health. Then, either on their own or with support from a community pharmacist, the community paramedic conducts a medication reconciliation process, which will ensure there are no contraindications, drug-drug interactions, or drug-disease interactions that may cause harm.
A final responsibility of medication management is to provide patient education. The community paramedic can work with the patient and their family or caregiver to ensure they understand how and when to take each medication, along with any potential warning signs of adverse drug events that should be shared with their primary care provider.
Community paramedics conducting home visits are well-positioned to observe any issues in the patient's home that may pose safety risks. Particularly for elderly or frail patients, tripping hazards like throw rugs, broken stairs, ill-fitting slippers, or electrical cords may pose a risk for falls. Up to half of falls may be caused by these environmental risk factors. Home safety checks can help identify modifications that make it easier and safer for patients to age in place, including installing grab bars, adequate lighting, and non-slip surfaces.
By identifying these issues early, community paramedics can prevent accidents that may later result in a 911 call or emergency room visit.
Community paramedicine programs can also conduct safety checks of home durable medical equipment (DME) like nebulizers, wheelchairs, or continuous positive airway pressure (CPAP) machines. They can also help manage maintenance and distribution of DME for community lending closets that provide access to patients who are otherwise unable to obtain DME on their own.
Chronic Disease Management
People living in rural communities are more likely to have multiple chronic conditions, which has a significant impact on quality of life. With the right tools, including patient education, people can often manage their condition at home. This results in better long-term outcomes and saves both time and money for the patient and the health system.
Community paramedicine programs focus on a range of chronic conditions including diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and asthma, depending on the needs of their patient population. Their activities include checking and counseling patients on blood glucose levels, conducting regular weigh-ins with patients living with CHF, checking blood oxygen levels, and discussing the patient's current disease management strategies so they can be modified as needed.
As described by EMS World, a community paramedic engages the patient in an iterative process to ensure they understand how best to manage their disease. This includes education about symptoms, lifestyle modifications, warning signs for worsening health, and proper use of medication or equipment. The patient also works with the community paramedic to practice their self-monitoring and disease management techniques and teaches-back their medical plan to the paramedic.
Examples of Rural Prevention and Health Education Programs using Community Paramedics
- The Help for Seniors program in Livingston County, New York, works with older adults in the community to identify unmet health needs. It also educates emergency medical services (EMS) providers on geriatric health issues. The program includes in-home screening for falls risk, medication management needs, and depression. Of program participants, 91% had identified needs that were then referred to case managers for a follow-up home visit.
- Rio Rico Medical & Fire District's Community Healthcare Integrated Paramedicine Program (CHIPP) is a comprehensive program designed to fill gaps in the healthcare system in south central Arizona. CHIPP has developed detailed policy manuals that describe all assessments and activities that will be conducted with patients who need support managing chronic conditions including asthma, COPD, hypertension, CHF, and dementia.
- ThedaCare and Gold Cross Ambulance in northeastern Wisconsin have partnered to develop a community paramedicine program that serves a variety of patients referred from hospital and primary care settings. Through funding from the Moore Foundation's Community Management of Medication Complexity Innovation Lab, the team was able to expand its program to focus on patients whose complex prescription regimens put them at increased risk of hospitalization. By developing a Medication Risk Score, community paramedics were better able to assess which patients needed extra support to improve their health.
Considerations for Implementation
Community paramedics may rely on the services of other health professionals to deliver prevention services or education messages to their patients. For example, a pharmacist may be needed to review medication lists to identify potential drug interactions or incorrect dosages. However, they may be unable to attend the home visit in person due to distance or competing priorities. Telehealth can be a valuable tool to facilitate participation in the visit.
If programs are using telehealth to deliver services, access to high-speed internet is often necessary. For patients without high-speed internet in their home or who live in places without high-quality cell phone service, this can be a key limitation. Some community paramedicine programs have installed hot spots in their vehicles or have provided signal boosters to patients in order to better facilitate communication with other healthcare providers. For more information about broadband access, see Module 4: Implementation Considerations.
Program Clearinghouse Examples
- Manatee County Department of Public Safety Community Paramedic Program
- Queen Anne's County Mobile Integrated Community Health (MICH) Program
- United Ambulance Service
Resources to Learn More
Always Use Teach-Back! Training Toolkit
Teaches healthcare providers how to use the teach-back method when providing education or coaching to patients. Includes an online learning module offering opportunities to practice the teach-back method in hospital, home health, and primary care settings.
Organization(s): Institute for Healthcare Advancement
Disease Management for the Community Paramedic
Identifies several components important to include when integrating chronic disease management into a community paramedicine program. Discusses the social determinants of health model and the factors that influence a patient's ability to manage their condition at home.
Author(s): Dan Swayze
Organization(s): EMS World
Community Integrated Paramedicine
Provides resources for healthcare providers and patients to explain the goals and purpose of community paramedicine. Includes condition-specific example forms and tools that are used by community paramedics to conduct patient visits.
Organization(s): Rio Rico Medical & Fire District, Community Healthcare Integrated Paramedicine Program
Safety Assessment Checklist
Offers a comprehensive list of safety features to be assessed during patient home visits to identify problems or issues that may increase their risk of falls or other injury.
Author(s): Kevin Creek
Organization(s): Idaho Department of Health and Welfare, Western Eagle County Health Services District
Home Safety Assessment
Identifies potential risks to newborns and small children including outdoor hazards like pools or hot tubs and indoor hazards like appliance cords or unsecured furniture.
Author(s): Magen Hall
Organization(s): The South Carolina Community Paramedic Advisory Committee, Abbeville County EMS