Prehosp Emerg Care. 2019 Sep-Oct;23(5):718-729. doi: 10.1080/10903127.2019.1566421. Epub 2019 Feb 4.
Older adults account for 38-48% of emergency medical service (EMS) calls, have more chronic diseases, and those with low income have lower quality of life. Mobile integrated health and community paramedicine may help address these health inequalities and reduce EMS calls. This study examines the effectiveness of the Community Paramedicine at Clinic (CP@clinic) program in decreasing EMS calls and improving health outcomes in low-income older adults. This was an open-label, pragmatic, cluster-randomized controlled trial conducted within subsidized public housing buildings for older adults in 5 paramedic services across Ontario, Canada. A total of 30 apartment buildings were eligible (>50 units, >60% of units occupied by older adults, unique postal code, available match for pairing). Paired buildings were randomly allocated to intervention (CP@clinic for one year) or control (usual care) via computer-generated randomization. The CP@clinic intervention is a community-based, paramedic-led, health promotion and disease prevention program held weekly in building common rooms. CP@clinic includes risk assessment with validated tools, decision support, health promotion, referrals to resources, and reports back to family doctors. All residents could participate, but only older adults (55 years and older) were included in analyses. The primary outcome was building-level EMS calls from paramedic service databases. Secondary outcomes were individual-level changes in chronic disease risk factors and quality-adjusted-life-years (QALYs). Data were analyzed using Generalized Estimating Equations to account for clustering by sites. Intention-to-treat analysis showed no significant difference in EMS calls (mean difference = -0.37/100 apartment units/month, 95%CI: -0.98 to 0.24). Sensitivity analysis excluding data from 2 building pairs with eligibility changes after intervention initiation revealed a significant difference in EMS calls in favor of the intervention buildings (mean difference = -0.90/100 apartment units/month, 95%CI: -1.54 to -0.26). At the individual level, there was a significant QALY increase (mean difference = 0.06, 95%CI: 0.02 to 0.10) and blood pressure decrease (systolic mean change = 3.65 mmHg, 95%CI: 2.37 to 4.94; diastolic mean change = 2.03 mmHg, 95%CI: 1.00 to 3.06). CP@clinic showed a significant decrease in EMS calls, decrease in BP, and improvement in QALYs among older adults in subsidizing public housing, suggesting this simple program should be replicated in other communities with public housing. Clinicaltrials.gov, Registration no. NCT02152891.
老年人占急救医疗服务（EMS）呼叫的 38-48%，他们有更多的慢性疾病，而收入较低的老年人生活质量较低。移动综合健康和社区护理人员可能有助于解决这些健康不平等问题，并减少 EMS 呼叫。本研究旨在探讨社区护理人员在诊所（CP@clinic）方案在减少低收入老年人的 EMS 呼叫和改善健康结果方面的有效性。这是一项在加拿大安大略省 5 个护理服务机构的补贴公共住房建筑内进行的、开放标签、务实、集群随机对照试验。共有 30 栋公寓楼符合条件（>50 个单元，>60%的单元由老年人居住，独特的邮政编码，可用于配对）。通过计算机生成的随机化对配对建筑物进行随机分配干预（CP@clinic 持续一年）或对照（常规护理）。CP@clinic 干预是一种基于社区的、由护理人员领导的、促进健康和预防疾病的方案，每周在建筑物的公共休息室举行。CP@clinic 包括使用经过验证的工具进行风险评估、决策支持、健康促进、转介资源和向家庭医生报告。所有居民都可以参加，但只有老年人（55 岁及以上）被纳入分析。主要结局是从护理服务数据库中获得的建筑物级别的 EMS 呼叫。次要结局是慢性病危险因素和调整后的生命年（QALY）的个体水平变化。使用广义估计方程分析数据，以考虑站点聚类。意向治疗分析显示，EMS 呼叫无显著差异（平均差异=-0.37/100 个公寓单元/月，95%CI：-0.98 至 0.24）。排除干预启动后资格发生变化的 2 对建筑物的数据后进行敏感性分析显示，干预组的 EMS 呼叫有显著差异（平均差异=-0.90/100 个公寓单元/月，95%CI：-1.54 至 -0.26）。在个体水平上，QALY 显著增加（平均差异=0.06，95%CI：0.02 至 0.10），血压下降（收缩压平均变化=3.65mmHg，95%CI：2.37 至 4.94；舒张压平均变化=2.03mmHg，95%CI：1.00 至 3.06）。CP@clinic 显示，在补贴公共住房的老年人中，EMS 呼叫显著减少，血压下降，QALY 改善，这表明该简单方案应在其他有公共住房的社区中复制。Clinicaltrials.gov，注册号 NCT02152891。
