2017-02-17 / Health & Wellness

Community paramedic pilot project gets the ‘A’ grade

By Hector Gonzalez

A pilot project that trains paramedics to provide medical care beyond the first-responders’ traditional roles of simply transporting patients to emergency rooms could save lives and money if it was duplicated across the state, according to a report released last month.

Researchers at UC San Francisco evaluated how well the community paramedic project worked in Ventura and 12 other counties where it was tested between January 2015 and November 2016, releasing their final report Jan. 26.

In every county where it was tried, the pilot project developed by the state Emergency Medical Services Authority reduced medical costs, cut emergency room visits and improved patient care, the report found.

In Ventura County, the community paramedic project trained 13 paramedics from American Medical Response in Moorpark, Gold Coast Ambulance Services in Oxnard and Life Line Medical Transport in Ventura to provide hospice care and to help tuberculosis patients stick with their medication regimens.

“Through these projects, we’ve demonstrated that when paramedics partner with other parts of the healthcare system like TB clinics and hospice providers, it’s possible to provide better care at a lower cost,” said Mike Taigman, who oversaw the hospice community paramedic pilot project in Ventura County.

Among the 226 patients in Ventura County who enrolled in the hospice project, ambulance transports of those patients to emergency rooms dropped from 80 percent before the pilot project to 36 percent when trained community paramedics intervened to provide hospice care, the report said.

Community paramedics provided patients and their families with emotional support and administered medications from the patients’ “comfort care” packs, which typically contain pain medicines, along with snacks, toiletries and other items used to comfort dying patients.

In all, hospice intervention by community paramedics resulted in a net savings of $719 per patient, the report found.

Community paramedics trained to assist tuberculosis care programs made sure patients completed their treatment programs and monitored patients for side effects that might require medication adjustments.

Because there are higher rates of TB transmission among those who live in poverty, such as the homeless and injection drug users, health experts say those patients may be less likely to follow the needed medication regime due to the drugs’ cost or the patients’ lack of access to healthcare. Those factors contribute to a greater risk of hospitalization for low-income TB patients.

About 30 TB patients in the county received care from trained community paramedics.

TB patients who were monitored through the pilot project were more likely to complete their regimen of treatments than patients not enrolled in the project, the report said.

If TB patients don’t complete their full medication regime, they’re at risk of spreading TB to others or “developing a drug-resistant strain of TB that would be more difficult to treat and to control in the community,” the report said

In Ventura County, the community paramedics were available to provide medicine to TB patients whenever they needed it, 24 hours a day, filling in for county Health Care Agency personnel who work only on weekdays.

“It definitely has benefited us,” Eva Reeder, who manages the county’s TB program, told the Acorn in December.

By making sure hard-to-reach TB patients took all their medications, the project “may have increased the number of patients in Ventura who were treated successfully for TB,” thereby cutting the expense of having to track down anyone who might have come into contact with and become infected by a non-compliant patient, the report found.

In all, the project trained some 80 traditional paramedics statewide to become community paramedics.

Elsewhere in the state, the pilot program trained paramedics to provide follow-up care for recently discharged patients; how to reduce emergency room visits by patients who frequently call 911; and how to evaluate patients with behavioral health issues or non-critical medical conditions who could be transported to a mental health or urgent care center instead of an emergency room.

“The community paramedicine pilot projects have demonstrated that specially trained paramedics can provide services beyond their traditional and current statutory scope of practice in California,” the report concluded. “These projects are improving patients’ well-being, improving the integration and efficiency of health services in the community, and decreasing health care costs by reducing ambulance transports, emergency department visits, and hospital readmissions.”

So what happens next?

Although the project expired after 12 months, some state lawmakers are considering preserving at least parts of it through legislation, Emergency Medical Services Authority spokesperson Adam Willoughby said.

“We’re hearing that one author, Assemblyman Mike Gipson, is considering a bill to keep the mental health alternative transport component of the project,” he said.

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