Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8.
Prehosp Emerg Care. 2013 Jul-Sep;17(3):361-72. doi: 10.3109/10903127.2013.792890.
Paramedics are an important health human resource and are uniquely mobile in most communities across Canada. In the last dozen years, challenges in the delivery of health care have prompted governments from around the globe to consider expanding the role paramedics play in health systems. Utilizing paramedics for the management of urgent, low-acuity illnesses and injuries has been coined "community paramedicine," but the role, safety, and effectiveness of this concept are poorly understood.
We undertook a systematic review of the international literature to describe existing community paramedic programs.
We used the Cochrane methodology for systematic reviews. An international group of experts developed a search strategy and a health information specialist executed this search in Medline, Embase, and CINAHL starting January 1, 2000. We included all research articles in the English language that reported a research methodology. We excluded commentaries and letters to the editor. Two investigators independently screened citations in a hierarchical manner and abstracted data.
Of 3,089 titles, 10 articles were included in the systematic review and one additional paper was author-nominated. The nature of the 11 articles was heterogeneous, and only one randomized controlled trial (RCT) was found. This trial showed community paramedicine to be beneficial to patients and health systems. The other articles drew conclusions favoring community paramedicine.
Community paramedicine research to date is lacking, but programs in the United Kingdom, Australia, and Canada are perceived to be promising, and one RCT shows that paramedics can safely practice with an expanded scope and improve system performance and patient outcomes. Further research is required to fully understand how expanding paramedic roles affect patients, communities, and health systems.
护理人员是重要的卫生人力资源，在加拿大大多数社区中具有独特的流动性。在过去的十几年中，医疗保健服务提供方面的挑战促使全球各国政府考虑扩大护理人员在卫生系统中发挥的作用。将护理人员用于管理紧急、低危疾病和伤害的做法被称为“社区护理”，但该概念的作用、安全性和有效性仍知之甚少。
我们对国际文献进行了系统评价，以描述现有的社区护理计划。
我们使用 Cochrane 系统评价方法。一组国际专家制定了搜索策略，并由一名健康信息专家自 2000 年 1 月 1 日起在 Medline、Embase 和 CINAHL 中执行了该搜索。我们纳入了所有以英文报告研究方法的研究文章。我们排除了评论和给编辑的信。两名调查员独立地以分层方式筛选引文并提取数据。
在 3089 个标题中，有 10 篇文章被纳入系统评价，另有 1 篇文章是作者提名的。这 11 篇文章的性质存在差异，仅发现了 1 项随机对照试验（RCT）。该试验表明，社区护理对患者和卫生系统有益。其他文章得出了支持社区护理的结论。
迄今为止，社区护理研究仍存在不足，但英国、澳大利亚和加拿大的计划被认为具有前景，并且一项 RCT 表明，护理人员可以在扩大范围的情况下安全地执业，从而改善系统绩效和患者结局。需要进一步研究以充分了解扩大护理人员角色如何影响患者、社区和卫生系统。
