“The Development of Community Paramedicine: A Restricted Review” (Shannon et al., 2022)

Key Takeaways

• Community paramedicine (CP) programs vary significantly in education, scope, governance, and outcomes internationally.
• Standardizing education and governance structures is critical for maximizing CP effectiveness.
• CP programs consistently demonstrate reductions in healthcare costs, emergency department visits, and hospital admissions.
• There is strong patient satisfaction with community paramedic interventions.

Introduction

In this review, we examine the findings from the paper “The Development of Community Paramedicine; a restricted review” by Shannon et al. (2022), which provides an international analysis of community paramedic programs focusing on education requirements, service delivery models, clinical governance, role scope, and outcomes.

Education Requirements for Community Paramedicine

Shannon et al. reveal a wide variation in education requirements for CP programs across different countries, ranging from short in-service training to comprehensive master’s-level education programs. The lack of consistent training standards is highlighted as a significant barrier to establishing universal CP roles and competencies. The authors argue for the development of clearly defined educational standards tailored to meet specific community needs and CP program objectives.

Service Delivery Models

The review categorizes several prominent CP delivery models:

• Community Assessment and Referral: Connecting patients with necessary healthcare and community resources.
• Home Visit Programs: Targeting patients at high risk for frequent EMS usage or hospital admissions.
• Specialist Response: CPs providing specialized care in coordination with traditional EMS.
• Remote Patient Monitoring: CPs managing chronic diseases through remote monitoring.
• Mental Health and Addictions Support: CP involvement in crisis teams and community-based mental health interventions.

Clinical Governance and Supervision

Shannon and colleagues emphasize that clear governance and supervision are essential yet inconsistently implemented across CP programs. Successful CP programs typically include clear clinical guidelines, structured oversight by medical directors, and effective integration into broader healthcare teams. However, variability and inadequate governance structures are common, potentially hindering CP effectiveness.

Scope of Community Paramedic Roles

The scope of practice for CPs varies widely but commonly includes:

• Comprehensive health assessments
• Psychosocial assessments and management
• Health promotion and illness prevention activities

The review emphasizes that paramedics’ ability to conduct holistic assessments and engage in preventive care positions them uniquely to address community health needs effectively.

Outcomes and Impact of Community Paramedicine Programs

The review strongly supports CP programs’ value, showing consistent positive outcomes:

Community Paramedics Reduced Emergency Department Visits and EMS Calls

Programs reviewed by Shannon et al. showed a significant reduction in emergency department visits, ranging from 21% to nearly 59% compared to traditional EMS pathways. Additionally, there was an observable decline in EMS call volumes by as much as 26%.

Economic Impact

CP programs demonstrated substantial economic benefits, significantly reducing healthcare utilization costs by diverting patients from unnecessary hospital visits. In one notable example, CP initiatives generated a return on investment ranging from 20% to substantial annual cost savings per patient.

Patient Health Outcomes

Positive impacts on patient health outcomes were documented, including improvements in chronic disease management such as hypertension and diabetes, enhanced quality of life, and decreased hospital readmissions.

Community Paramedics Provide High Patient Satisfaction

Patients reported high satisfaction with CP services, appreciating the personalized care, health education, and the convenience of receiving healthcare at home. This aspect greatly contributes to the positive perception and acceptance of CP programs in communities.

Challenges in Community Paramedicine

The article identifies several key challenges:

• Lack of standardized educational frameworks
• Inconsistent governance and supervision
• Variable integration with existing healthcare systems
• Need for better-defined role scopes

Recommendations for Future Community Paramedicine Development

Shannon et al. recommend:

• Conducting comprehensive community needs assessments before implementing CP programs.
• Developing standardized, competency-based education tailored to specific community needs.
• Establishing consistent governance, clinical supervision, and clearly defined role scopes.
• Utilizing comprehensive and diverse outcome measures to fully evaluate program effectiveness.

Shannon et al.’s review underscores the considerable benefits and potential of community paramedicine, particularly in reducing healthcare utilization and costs while improving patient outcomes and satisfaction. However, significant gaps remain, particularly regarding education standardization and clear governance structures, which must be addressed to fully realize CP’s potential.

Next in the Series

Our next review will explore “Standardizing Community Paramedic Education: Essential Competencies for Future Success,” detailing the educational frameworks vital for CP effectiveness.

See all of our articles on Community Paramedicine, MIH, and Community EMS here.

References

Shannon, B., Eaton, G., Lanos, C., Leyenaar, M., Nolan, M., Bowles, K.-A., Williams, B., O’Meara, P., Wingrove, G., Heffern, J., & Batt, A. (2022). The development of community paramedicine; a restricted review. Health & Social Care in the Community, 30(6), e3547-e3561. https://doi.org/10.1111/hsc.13985