Wilkinson-Stokes Matt, Yap Celene Y L, Crellin Di, Bange Ray, Braitberg George, Gerdtz Marie
Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Grattan Street, Parkville, VIC, 3054, Australia.
School of Health, Medical, and Applied Sciences, Central Queensland University, Bruce Highway, Rockhampton, QLD, 4702, Australia.
BMC Health Serv Res. 2025 Apr 10;25(1):533. doi: 10.1186/s12913-025-12614-y.
Globally, ambulance services face overwhelming primary and urgent care presentations that they are not structurally or culturally designed to manage efficiently or effectively. One mechanism to meet this consumer demand is the implementation of Paramedic Practitioner models with postgraduate qualifications in primary and urgent care. This study explores interest-holder views on reactive Paramedic Practitioner models within Australian ambulance services.
A multidisciplinary team representing ambulance services was formed, including paramedicine, nursing, and medicine. A realist lens was adopted, and a qualitative research design using inductive thematic analysis employed. Semi-structured focus groups or interviews were conducted to obtain data from 56 participants. Interest-holders represented included consumers (n = 16), members of parliament (n = 3), government executives (n = 8), industry executives representing emergency medicine, general practice, nursing, and paramedicine (n = 6), ambulance service executives and medical directors (n = 7), researchers (n = 8), and practicing clinicians from paramedicine, nursing, and medicine (n = 8).
Consumers described calling ambulance services for non-emergency complaints as they didn't know if their concern was an emergency or not, not wanting to go to hospital, and wanting someone to listen to them, reassure them, and then quickly solve their problem on the spot: they saw Paramedic Practitioners as aptly meeting this need. Among the healthcare professions, opinions were divided. Most participants were largely unfamiliar with Paramedic Practitioners or the evidence base supporting this model of practice, the concept received widespread support at the clinician level, and a small but avidly dissenting contingent of national policymakers opposed the models. Paramedic Practitioner models were considered to require broad support across the healthcare system to be effective. Policymakers were unsure which outcomes they wanted measured to evaluate models.
This study reports a wide range of interest-holder perspectives on the use of reactive Paramedic Practitioners within Australian ambulance services. Enablers (n = 10) and barriers (n = 10) to efficient and effective Paramedic Practitioner models were identified. Key outcomes of interest (n = 6) were identified, and these may be operationalised in future evaluations of reactive Paramedic Practitioner programs.
在全球范围内，救护车服务面临着大量的初级和紧急护理需求，而其在结构和文化上并不适合高效或有效地处理这些需求。满足这种消费者需求的一种机制是实施具有初级和紧急护理研究生资格的护理人员从业者模式。本研究探讨了澳大利亚救护车服务中利益相关者对反应性护理人员从业者模式的看法。
组建了一个代表救护车服务的多学科团队，包括护理、护理和医学专业人员。采用了现实主义视角，并运用归纳主题分析的定性研究设计。进行了半结构化焦点小组或访谈，以从56名参与者那里获取数据。利益相关者包括消费者（n = 16）、议会议员（n = 3）、政府行政人员（n = 8）、代表急诊医学、全科医学、护理和护理的行业行政人员（n = 6）、救护车服务行政人员和医疗主任（n = 7）、研究人员（n = 8）以及来自护理、护理和医学的执业临床医生（n = 8）。
消费者表示，他们因不知道自己的担忧是否属于紧急情况、不想去医院以及希望有人倾听、安慰并当场迅速解决他们的问题而拨打救护车服务电话寻求非紧急投诉的帮助：他们认为护理人员从业者能够恰当地满足这一需求。在医疗行业中，意见存在分歧。大多数参与者对护理人员从业者或支持这种实践模式的证据基础大多不熟悉，该概念在临床医生层面得到了广泛支持，但一小部分强烈反对的国家政策制定者反对这些模式。护理人员从业者模式被认为需要整个医疗系统的广泛支持才能有效。政策制定者不确定他们希望衡量哪些结果来评估这些模式。
本研究报告了澳大利亚救护车服务中利益相关者对使用反应性护理人员从业者的广泛观点。确定了高效和有效的护理人员从业者模式的促进因素（n = 10）和障碍（n = 10）。确定了关键的关注结果（n = 6），这些结果可能会在未来对反应性护理人员从业者项目的评估中得到应用。
