安大略省频繁使用紧急医疗服务的患者家庭社区医疗计划（CP@home）的有效性：一项随机对照试验。

Effectiveness of the community paramedicine at home (CP@home) program for frequent users of emergency medical services in Ontario: a randomized controlled trial.

机构信息

Department of Family Medicine, McMaster University, Hamilton, ON, Canada.

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

出版信息

BMC Health Serv Res. 2024 Nov 25;24(1):1462. doi: 10.1186/s12913-024-11952-7.

DOI:10.1186/s12913-024-11952-7

PMID:39587610

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11590269/

Abstract

OBJECTIVE

To evaluate the impact of the Community Paramedicine at Home (CP@home) program, a community paramedicine home-visit intervention, on reducing emergency medical services (EMS) calls among frequent users.

DESIGN

A 6-month, open-label, pragmatic, randomized controlled trial with parallel intervention and control arms. An online automated platform (randomizer.org) was used to randomly allocate participants using a 1:1 allocation sequence.

SETTING

In homes of frequent EMS users in four paramedic services and regions across Ontario, Canada.

PARTICIPANTS

Eligible participants were frequent callers (≥ 3 EMS calls within six months and ≥ 1 EMS call within the previous month), or had ≥ 1 lift assist call within the previous month, or were referred by paramedics.

INTERVENTION

Community paramedics conducted risk assessments, provided health education, referred appropriate resources, and reported to family physicians for up to three home visits. The control arm received usual care.

PRIMARY OUTCOME MEASURE

EMS calls in 6 months during intervention.

RESULTS

Two thousand two hundred eighty four eligible participants were randomly allocated to the intervention and control groups, with 265 participants lost to follow-up due to inability to retrieve participant records from EMS databases. There were 1025 intervention participants (52.7% female, mean age 69.65 years [standard deviation (SD) = 19.98]) and 994 control participants (52.0% female, mean age 69.78 years [SD = 19.09]). In the post-intervention intention-to-treat analysis (zero-inflated negative binomial regression), the EMS call rate was not significantly lower in the intervention group compared to the control group (incidence rate ratio [IRR] = 0.88, 95% confidence interval [CI]: 0.76, 1.01). In the subgroup analysis, the intervention had a significant effect in the lift assist caller subgroup (IRR = 0.73, 95% CI: 0.58, 0.92), but no significant effect among the frequent caller subgroup (IRR = 0.97, 95% CI: 0.82, 1.14). The sensitivity analyses found a similar association for the lift assist caller subgroup. There was a significant subgroup effect (p-value for interaction < 0.01).

CONCLUSIONS

CP@home had a significant impact on reducing EMS calls for those with a lift assist call but not for the overall sample. This program filled a healthcare gap by shifting primary care delivery, which could reduce the disproportionate number of EMS calls, thus reducing healthcare costs.

TRIAL REGISTRATION

Registered with ClinicalTrials.gov NCT02835989 on July 14, 2016.

摘要

目的

评估社区医疗居家计划（CP@home）的效果，该计划是一项社区护理家访干预措施，以减少频繁使用急救医疗服务（EMS）的人群的 EMS 呼叫次数。

设计

一项为期 6 个月、开放标签、实用、随机对照试验，具有平行干预和对照组。参与者使用在线自动平台（randomizer.org），通过 1:1 分配序列进行随机分组。

地点

在加拿大安大略省四个护理服务和地区的频繁使用 EMS 的家庭中。

参与者

合格的参与者是频繁的呼叫者（在六个月内有≥3 次 EMS 呼叫，在过去一个月内有≥1 次 EMS 呼叫），或在过去一个月内有≥1 次举升辅助呼叫，或由护理人员转介。

干预措施

社区护理人员进行风险评估，提供健康教育，转介适当的资源，并向家庭医生报告最多三次家访。对照组接受常规护理。

主要结局指标

干预期间的 6 个月内的 EMS 呼叫次数。

结果

2284 名符合条件的参与者被随机分配到干预组和对照组，由于无法从 EMS 数据库中检索参与者记录，有 265 名参与者失访。干预组有 1025 名参与者（52.7%女性，平均年龄 69.65 岁[标准差（SD）=19.98]），对照组有 994 名参与者（52.0%女性，平均年龄 69.78 岁[SD=19.09]）。在干预后的意向治疗分析（零膨胀负二项回归）中，干预组与对照组相比，EMS 呼叫率没有显著降低（发病率比[IRR] = 0.88，95%置信区间[CI]：0.76，1.01）。在亚组分析中，干预措施在举升辅助呼叫亚组中具有显著效果（IRR = 0.73，95% CI：0.58，0.92），但在频繁呼叫亚组中没有显著效果（IRR = 0.97，95% CI：0.82，1.14）。敏感性分析发现，举升辅助呼叫亚组存在类似的关联。存在显著的亚组效应（交互作用的 p 值<0.01）。