Community Paramedicine in a Rural FHT West …...Community Paramedicine (CP) Program •In 2014 the...
Transcript of Community Paramedicine in a Rural FHT West …...Community Paramedicine (CP) Program •In 2014 the...
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F a m i l y H e a l t h Te a m s
Équipes de santé familiale
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Community Paramedicine in a Rural FHTWest Carleton Family Health Team (WCFHT)
AFHTO Conference2015
Beverley Atkinson2015/10/28
QIDSS Supporting the Champlain
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Presenter Disclosure
• Presenters: Beverley Atkinson/Steve Pancino
• Relationships with commercial interests:• Grants/Research Support: None
• Speakers Bureau/Honoraria: None
• Consulting Fees: None
• Other: None
• Disclosure of Commercial Support• None
AFHTO 2015 Conference
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Community Paramedicine (CP) Program
• In 2014 the Ministry of Health and Long Term Care (MOHLTC) distributed $6 million dollars to initiate or expand paramedic programs in Ontario
• Thirty projects/programs were chosen
• WCFHT was chosen to integrate a Community Paramedic into the FHT to provide patients, services in their own home.
• The program started in October 2014 and is funded until October 2015 with potential for extension.
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Reduce
Stress on Limited Health
Services
Improve Quality of
Life
Patients
Chronic Diseases
Co-morbidities
Palliative
At risk
Mental Health
Hospitalized
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Patient Population
Program
Purpose
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Patient Population
• Up until September 30/2015 - 118 patients enrolled in the program.
• The average number of medications per patient 11. 69
• Emergency department visits• 30% Falls
• 36% Palliative
• 22% Emergencies
• 11% Preventable
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INTERVENTIONS
Identification of patients with high glucose levels
Identification of a patient with Lithium Toxicity
28 Non-Prescriptions Discrepancies
23 Prescription Discrepancies
18 Drug Related Concerns
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Harold
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Medically complex and non-
compliant. He lives alone, is socially
isolated ,has transportation and home
safety issues.
:
Harold now receives community
services such as Primary Care
Outreach, CCAC for wound care, Fire
Department (smoke detectors)
Harold and Tracey
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Patient Entry
into CP
Program
Tracey and Janine
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Why a Community Paramedic
• Medical, Health and Safety, Environmental Assessments, Defuse Conflict and AddictionsTraining
• Car, drugs and medical supplies/equipment, back-fill , relationship with police and community supports GPS dispatch for personnel safety
Infrastructure/Logistical Support
• Paramedics instill trust; point of care testing, immunizations, keen assessment skills and a thorough identification of medications
Scope of Practice
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Home
• Palliative
• Complex Patients
• Preventative Care
Hospital
• Post Hospital Visits
• Prevent Readmission
• Reduce 911 Calls
Community
• Advocacy
• Access to FHT Primary Care
• Social Services
Patient
Benefits
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Paramedic Service Benefits
• Enhanced opportunities for Paramedic Service personnel skills ,development and maintenance.
• Increase in Scope of Practice
• Prevention of repeat 911 calls that use up limited resources
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Ottawa
Paramedic
Services
Renfrew County
Paramedic
Services
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WCFHT Benefits
• Supports patient outreach
• Eyes and ears for polypharmacy for patients
• Identifies continuous improvement opportunities
• Stronger partnerships with hospitals, CCAC and other community partners
• “Right Care, Right Time, Right Patient”
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Patient Request versus FHT Request
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0
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W4
0W
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4W
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8W
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2012 2013 2014 2015
Nu
mb
er
of C
on
tacts
Weeks
Patient Versus FHT Requests
Pt Request FHT Request CP
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Benefits of the Health System
• Bridging acute and primary care
• Potential savings in reducing or alleviating ER loads, and decreasing the length of stay in hospitals
• Improve the coordination and continuity of care.
• Increased access to primary care for medically underserved populations
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“My role as a paramedic isn’t always to
save a life… sometimes it is to simply make
their transition comfortable” … Australian
Paramedic
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We cannot solve our problems with the same thinking we used when we
created them."
Albert Einstein
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Community Paramedics Improving Patient Outcomes
• MOH one time funding
• March 2nd program began
• Currently 70 active rostered patients (top 1% of health system users)
• Funding through to October 31st
• 13 community stakeholders
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Meet John
Synopsis
• 11 ED visits & 5 Admissions – 12
months (4 admissions/6 weeks)
• Orphaned client (no primary
care provider)
• 8 Community services(Rapid response nurse, Respiratory therapist, Social worker, Speech language therapist, Community nurse, Community nurse practitioner, Occupational therapist, Personal support worker, Age well nurse)
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John today……….
Synopsis
• No ED Visits / Admissions in
18 weeks
• Primary care provider –
Quarterback of care
• 2 Community services:
• Community Paramedicine Program• Community Nursing
• Shopping at Walmart
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Program Background
• Primary Care Paramedics
• 8 week custom program at Fanshawe College
• COPD, CHF, Diabetes, Advance Care Planning, NHS Wellness Index, Geriatrics
• Point of Care Testing
• Direct access to primary care
• Integrated into Chatham-Kent Health Link
• Non-response vehicle
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Referral Pathways
• Chatham-Kent Health Link• top 5% of health users overseen by care
coordinators
• Cardiac Rehab from Community Health Centre• Waitlisted patients for cardiac rehab program
• CCAC Rapid Response RN program• Post discharge COPD/CHF
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Preliminary Results – 6 months
• 92% reduction in 9-1-1 calls
• 85 fewer ED admissions
• XXXXX Reduced Hospital Admissions
• Improved Wellness Index by XXXXXX
• Improved Access to Primary Care
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Next Steps
• Program evaluation by Odette School
of Business
• Fine tuning of referral pathways
• Sustainability
• Working with municipality and other
stakeholders to change the way in
which paramedic services are
delivered in the community from a
solely reactive system to a proactive
system
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