Community Paramedicine Applied in a Rural Community

Abstract

Research objective: Abbeville County Emergency Management Services (ACEMS) began a community paramedicine (CP) program to utilize trained paramedics to serve patients who frequently use the emergency department (ED) and have 1 or more of the following diagnoses: hypertension, diabetes, chronic heart failure, asthma, and chronic obstructive pulmonary disease. The objective of this study was to determine if the CP program reduced ED visits in Abbeville while improving patient outcomes.

Design: A pre/posttest with a comparison group study design was used to evaluate the CP program. The study population had 193 patients (68 enrollees and 125 comparisons) who resided in Abbeville County, South Carolina. Frequent users of the ED were recruited and enrolled in the program by Abbeville Area Medical Center (AAMC) staff starting in October 2013. Records from both AAMC and ACEMS were examined to determine the impact of the CP program.

Results: Hypertensive patients decreased an average of 7.2 mmHg (P < .0001) in systolic blood pressure and 4.0 mmHg (p < .0001) in diastolic blood pressure. Diabetic patients decreased blood glucose by an average of 33.7 mmol/L (p = .0013). Following enrollment into the program, CP participants decreased ED visits by 58.7% and inpatient visits by 68.8%. Conversely, the comparison group increased ED visits by 4.0% and inpatient visits by 187.5%.

Conclusions: The CP program demonstrated a meaningful difference in the health of participants while reducing their health care utilization. CP patients reduced their ED and inpatient use, required less intensive care, had better health outcomes, and reduced health expenses to the community.

Keywords: community paramedicine; emergency services; program evaluation; rural.