PHECC Community paramedicine practice framework scoping exercise and restricted review

Community Paramedicine Practice Framework Scoping Exercise

To gain an insight into how community paramedicine systems operate in other jurisdictions, PHECC have partnered with Monash University, Australia to conduct an international community paramedicine practice framework scoping exercise. Systems operating in Australia, Canada, New Zealand, United Kingdom, Finland and the USA were examined to determine scope of practice, models of service delivery, educational standards, practitioner entry requirements and integration with primary care. In addition, an appreciation of barriers and facilitators to community paramedicine schemes was sought and is documented in the report.

The report is comprehensive and provides valuable information to the PHECC community paramedicine sub-committee, PHECC Executive and Council as we progress this important project. PHECC are grateful to Brendan Shannon, Alan Batt, Georgette Eaton, Kelly-Ann Bowles, Brett Williams and all of the international contributors who were instrumental in the production of the scoping report.

Read the practice framework scoping exercise here:

Community Paramedicine Restricted Review

Community paramedicine is defined as “a model of care whereby paramedics apply their training and skills in ‘non-traditional’ community-based environments, often outside the usual emergency response and transportation model. The community paramedic practices within an ‘expanded scope’, which includes the application of specialised skills and protocols beyond the base paramedic training. The community paramedic engages in an ‘expanded role’ working in non-traditional roles using existing skills”. Complementing that definition, a community paramedicine programme has been defined as “a program that uses paramedics to provide immediate or scheduled primary, urgent, and/or specialized healthcare to vulnerable patient populations by focusing on improving equity in healthcare access across the continuum of care.” Together these definitions provide a foundation to guide health services in the development of a community paramedicine framework.

Community paramedicine has evolved from humble beginnings in Nova Scotia and is now widely implemented across much of Australasia, Canada, Finland, Ireland, the United Kingdom (UK), and the United States of America (USA). The main drivers for the community paramedicine model have been the changing paramedic service caseloads that reflect aging populations and declining access to other health services. These community paramedicine models provide an opportunity for community paramedics to more widely be employed across the health system in ‘non-traditional’ roles that meet the needs of disadvantaged communities who often lack access to high-quality emergency health services or primary health care. However, for health services looking to implement community paramedicine programmes, there can be many factors to navigate, and the siloed nature of healthcare means many programmes are built without consultation with the wider experience base both domestically and internationally. This leads to difficulties for regulatory bodies when looking to define scope of practice and entrance requirements for community paramedicine programmes. This restricted review of the literature provides a collation of evidence to support the introduction of community paramedicine into any jurisdiction for any governing bodies.

Review aims
The aim of this restricted review was to explore and better understand the successes and learnings of community paramedic programmes with a focus on Australasia, Canada, Finland, Ireland, the UK, and the USA context. It includes a review of the published research (both peer-reviewed and grey literature) on the following topics:
● Education;
● Models of delivery including clinical governance, supervision, and other structural supports;
● Scope of community paramedicine roles; and
● Outcomes associated with community paramedic programmes.

The initial search strategy and referencing chaining of the final included peer-reviewed studies yielded 10,130 publications for screening. After elimination of duplicates (2,148) we screened 7,992 studies at the title and abstract level. This led to the exclusion of 7,579 citations. The remaining 405 full-text publications were reviewed (8 were not able to be retrieved) with another 312 publications excluded. We identified an additional five publications through searches of grey literature, resulting in a final yield of 98 publications included in this review. Includes works were published between 2003 and 2021, with the majority published from 2016 onwards (69 of 98 studies). The majority of studies were from the USA (n=37, 38%), followed by Canada (n=29, 30%) and the UK (n=16, 16%). The majority of studies reported on outcomes of community paramedicine programmes (n=50, including quality of life, patient satisfaction, and economic impacts), followed by models of delivery (n=28, including clinical governance, supervision, and other structural supports). A number of studies reported on more than one of the descriptive categories
The findings of this review demonstrate a lack of research and understanding in the areas of education and scope of the role for community paramedics. The findings highlight a need to develop common approaches to education and scope of role while maintaining flexibility in addressing community needs. There was an observable lack of standardisation in the implementation of governance and supervision models, which may prevent community paramedicine from realising its full potential. The outcome measures included in this review show that there is evidence to support the implementation of community paramedicine into healthcare system design. Community paramedicine programmes result in a net reduction in acute healthcare utilisation for enrolled patients, appear to be economically viable for the health service and result in positive patient outcomes with high patient satisfaction with care. There is a developing pool of evidence to many aspects of community paramedicine programmes. However, at this time, gaps in the literature prevent a definitive recommendation on the impact of community paramedicine programmes on healthcare system functionality

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