Indicators of paramedic service use by community dwelling older adults

Irish Journal of Paramedicine

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Field Value
Title Indicators of paramedic service use by community dwelling older adults
Creator Leyenaar, Matthew S
Tavares, Walter
Agarwal, Gina
Costa, Andrew P
Subject Health Services Research
Emergency department use, Paramedic service use, Repeated use, Case-finding, Risk scale
Description Introduction:  Home care clients represent a patient group that may be served through community paramedicine (CP) programs.  The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale was recently validated to identify levels of risk for use of emergency care among this population.  This study investigates whether frail home care clients that were identified as being at higher risk based on their DIVERT scores were more likely to use paramedic services to access the emergency department within 90 days of assessment when compared to clients that had lower DIVERT scores.Methods: A retrospective cohort study was conducted using regularly collected administrative data.  Home care assessment data were supplemented with data on emergency department (ED) visits.  Arrival by ambulance was modelled to control for DIVERT scores as well as several social and demographic variables.Results:  Within the cohort, approximately 40% of individuals visited an ED within 90 days of a home care assessment and almost half of all individuals visited an ED more than once within a year.  About two-thirds of clients that visited an ED in the 90 days following assessment used an ambulance for transportation.  DIVERT scores were predictive of this use with highest scores indicating 4.15 times higher odds of paramedic service use (95% CI 3.60-4.78Conclusion:  DIVERT was not developed to consider means of transportation to the ED.  The results indicate that it can be used to identify frail community dwelling older adults that are likely to use paramedic services to take them to the ED.  Further investigation of aspects of social isolation, carer resiliency, time of use, and characteristics associated with ED discharge are warranted.  Frequent ambulance use among this population suggests that collaboration between care providers may provide opportunities to prevent unnecessary ED visits by these individuals.
Publisher Irish College of Paramedics
Contributor Canadian Frailty Network Interdisciplinary Fellowship Program
Hamilton Niagara Haldimand Brant Local Health Integration Network (formerly the Hamilton Niagara Haldimand Brant Community Care Access Centre)
Date 2019-02-19
Type info:eu-repo/semantics/article
Original Research

Format application/pdf
Source Irish Journal of Paramedicine; Vol 4, No 1 (2019)
Language eng

Rights Copyright (c) 2019 Matthew S. Leyenaar, Walter Tavares, Gina Agarwal, Andrew P. Costa

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