Ottawa Paramedic Service, Ottawa, ON, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
CJEM. 2023 Apr;25(4):344-352. doi: 10.1007/s43678-023-00471-9. Epub 2023 Mar 10.
Long-term care (LTC) patients do poorly when transported to emergency departments (ED). Community paramedic programs deliver enhanced care in their place of residence, yet few programs are reported in the literature. We conducted a national cross-sectional survey of land ambulance services to understand if such programs exist in Canada, and what the perceived needs and priorities are for future programs.
We emailed a 46 question survey to paramedic services across Canada. We asked about service characteristics, current ED diversion programs, existing diversion programs specific to LTC patients, priorities for future programs, the potential impact of such programs, and what the feasibility and barriers are to implementing programs that treat LTC patients on-site, avoiding an ED visit.
We received responses from 50 sites across Canada, providing services to 73.5% of the total population. Almost a third (30.0%) had existing treat-and-refer programs, and 65.5% of services transported to destinations other than an ED. Almost all respondents (98.0%) felt the need for programs to treat LTC patients on-site, and 36.0% had existing programs. The top priorities for future programs were support for patients being discharged (30.6%), extended care paramedics (24.5%), and respiratory illness treat-in-place programs (20.4%). The highest potential impact was expected from support for patients being discharged (62.0%) and respiratory illness treat-in-place programs (54.0%). Required changes in legislation (36.0%) and required changes to the system of medical oversight (34.0%) were identified as top barriers to implementing such programs.
There is a significant mismatch between the perceived need for community paramedic programs treating LTC patients on-site, and the number of programs in place. Programs could benefit from standardized outcome measurement and the publication of peer-reviewed evidence to guide future programs. Changes in legislation and medical oversight are needed to address the identified barriers to program implementation.
长期护理（LTC）患者在被送往急诊科（ED）时情况不佳。社区护理人员计划在他们的居住地提供增强护理，但在文献中很少有计划被报道。我们对陆地救护车服务进行了全国性的横断面调查，以了解此类计划是否在加拿大存在，以及未来计划的需求和优先事项是什么。
我们向加拿大各地的护理人员服务机构发送了一份包含 46 个问题的电子邮件调查。我们询问了服务特征、当前的 ED 转移计划、专门针对 LTC 患者的现有转移计划、未来计划的优先事项、这些计划的潜在影响，以及在现场治疗 LTC 患者、避免 ED 就诊的计划的可行性和障碍是什么。
我们收到了来自加拿大各地 50 个地点的回复，为总人口的 73.5%提供服务。近三分之一（30.0%）有现有的治疗和转介计划，65.5%的服务是送往 ED 以外的目的地。几乎所有的受访者（98.0%）都认为有必要在现场治疗 LTC 患者的计划，而 36.0%的服务机构有现有的计划。未来计划的首要优先事项是为出院患者提供支持（30.6%）、扩展护理护理人员（24.5%）和呼吸疾病现场治疗计划（20.4%）。预期最高潜在影响来自于为出院患者提供支持（62.0%）和呼吸疾病现场治疗计划（54.0%）。立法方面的变更（36.0%）和医疗监督系统的变更（34.0%）被确定为实施此类计划的主要障碍。
在现场治疗 LTC 患者的社区护理人员计划的需求与现有的计划数量之间存在显著不匹配。这些计划可以从标准化的结果测量和同行评审证据的出版中受益，以指导未来的计划。需要对立法和医疗监督进行更改，以解决计划实施的障碍。
