Community Paramedicine

The CP@clinic Program was developed to help keep low-income older adults healthy at home and reduce avoidable 911 calls. Community paramedics (CPs) take on a novel non-urgent care role and visit with older adults in common rooms of social housing, addressing their unmet health needs. The CPs use evidence-based assessments to evaluate older adults’ health risks. Algorithms within the CP@clinic Program Database guide paramedics in setting health goals with program participants and providing tailored health education and referrals to primary care and community resources.

The CP@clinic Program has undergone a complete research cycle from pilot study, to multi-site cluster randomized controlled trial with an economic analysis (funded by CIHR), and is currently being scaled-up Canada-wide (funded by Health Canada) and into other settings including Indigenous communities. As a result of the COVID-19 pandemic, it has further been adapted to be implemented virtually (vCP@clinic). CP@clinic is implemented by 35% of all paramedic services across Ontario with pilot and expansion sites in other Canadian provinces, the UK, and Australia. CP@clinic has shown a consistent positive impact in decreasing 911 calls, improving health and quality of life of participants, and decreasing healthcare cost.

• In one subsidized housing building, CP@clinic Program significantly reduced 911 calls (25%)

• A two-year open-label pragmatic cluster-randomized controlled trial (RCT) was completed in Hamilton, ON. Results show that the mean monthly ambulance calls in intervention buildings (with CP@clinic) were significantly lower than in control buildings (without CP@clinic), by approximately 20 - 25%. Residents in intervention buildings displayed a significant improvement in quality adjusted life years (QALYs) and ability to perform usual activities, and a significant decrease in systolic and diastolic blood pressure (BP). The decrease in mean BP after participants’ 2nd and 4th visit was sustained across 10 or more visits.
• The results of the RCT were published in the Canadian Medical Association Journal (CMAJ) and received the Article of the year award from the CMAJ.

• An open-label, pragmatic, cluster-randomized controlled trial was conducted within subsidized housing buildings for older adults in 5 communities across Ontario. The CP@clinic Program showed a significant decrease in EMS calls, decrease in BP, and improvement in QALYs among older adult participants in subsidizing housing, suggesting this program should be replicated in other communities.

• Dr. Gina Agarwal and the McMaster Community Paramedicine Research Team were awarded Health Care Policy Contribution Program (HCPCP) funding by Health Canada to expand the innovative Community Paramedicine at Clinic (CP@clinic) program with paramedic services across Canada. This, along with the strong body of evidence supporting the CP@clinic Program, has facilitated collaboration with several interested paramedic services and community partners, and has led to this innovative program’s expansion to several populations and settings across Ontario.

• Canadian Frailty Network Funding provided enabled the evidence-based Community Paramedicine at Clinic (CP@clinic) program to be adapted for the population of a Northern First Nation community in Ontario. The goal of this study was to reduce frailty and improve the health of Indigenous older adults’. We used discussions with health workers and Indigenous older adults to determine the adaptations needed for the CP@clinic Program for Indigenous older adults.

• Delivery of CP@clinic in a Sikh Temple as an adaptation was a way to determine whether different strategies for care delivery would be acceptable. The novel introduction of future health care students as volunteers also raised awareness of health issues. This method can be adapted to other communities. Adapting the CP@clinic Program with volunteer translators for a Canadian South Asian population in a place of worship shows promise as an opportunity to address cardio-metabolic risk factors.

• In response to the COVID-19 pandemic, the standard CP@clinic Program Model has been adapted for all older adults connected to both new and current CP@clinic Program sites. This adaptation will protect the vulnerable populations targeted by the standard CP@clinic Program as well as new populations with a virtual program delivery option to reduce the risk for exposure to the COVID-19 virus and to provide equitable access to the program. This model also aims to improve chronic disease monitoring for older adults isolated due to the pandemic. Virtual CP@clinic includes an additional module which provides COVID-19 screening, education and pandemic preparedness.

• COVID-19 screening, education and pandemic preparedness

• The positive impact of the CP@clinic Program has received International acclaim with replication of the program in the UK (Swansea) and expansion to Australia (Ambulance Victoria) and USA (Kansas) is underway. Dr Agarwal is currently working with the Universities of La Trobe, Monash and Western Sydney in Australia with Dr Evelien Spelten and Dr Peter O’Meara to spread CP@clinic in Victoria. Krista Cockerell is a PHD Student on CP, being co-lead-supervised by Dr Agarwal. Dr. Tomas Barry, of University of Dublin is also working with her on preparatory work regarding integration of paramedics into General Practice in Ireland. Dr Ceri Todd, from Swansea, Wales, UK has worked with her in a proof of concept study of integrating paramedics into their Cluster-based Multidisciplinary Team/Primary Care Group