scholarly journals P016: Evaluating the impact of a novel mobile care team (MCT) on the prevalence of ambulatory care sensitive conditions presenting to emergency medical services in Nova Scotia

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S83-S83 ◽  
Author(s):  
D.R. Brown ◽  
A. Carter ◽  
J. Goldstein ◽  
J. Jensen ◽  
A. Travers ◽  
...  
Keyword(s):  
Primary Care ◽  
Ambulatory Care ◽  
Emergency Medical Services ◽  
Care Provider ◽  
Primary Care Provider ◽  
Care Team ◽  
Medical Services ◽  
Ambulatory Care Sensitive Conditions ◽  
Emergency Medical ◽  
One Year

Introduction: Hospitalization due to ambulatory care sensitive conditions (ACSC) is a proxy measure for access to primary care. Emergency medical services (EMS) are increasingly called when primary care cannot be accessed. A novel paramedic-nurse EMS Mobile Care Team (MCT) was implemented in an under-serviced community. The MCT responds in a non-transport unit to bookings from EMS, emergency and primary care and to low-acuity 911 calls in a defined geographic region. Our objective was to compare the prevalence of ACSC in ground ambulance (GA) responses before and after the introduction of the MCT. Methods: A cross-sectional analysis of GA and MCT patients with ACSC (determined by chief complaint, clinical impression, treatment protocol and medical history) one year pre- and one year post-MCT implementation was conducted for the period Oct. 1, 2012 to Sept. 30, 2014. Demographics were described. Predictors of ACSC were identified via logistic regression. Prevalence was compared with chi-squared analysis. Results: There were 975 calls pre- and 1208 GA/95 MCT calls post-MCT. ACSC in GA patients pre- and post-MCT was similar: n=122, 12.5% vs. n=185, 15.3%; p=0.06. ACSC in patients seen by EMS (GA plus MCT) increased in the post-period: 122 (12.5%) vs. 204 (15.7%) p=0.04. Pre vs post, GA calls differed by sex (p=0.007) but not age (65.38 ± 15.12 vs. 62.51 ± 20.48; p=0.16). Post-MCT, prevalence of specific ACSC increased for GA: hypertension (p<0.001) and congestive heart failure (p=0.04). MCT patients with ACSC were less likely to have a primary care provider compared to GA (90.2% and 87.6% vs. 63.2%; p=0.003, p=0.004). Conclusion: The prevalence of ACSC did not decrease for GA with the introduction of the MCT, but ACSC in the overall patient population served by EMS increased. It is possible more patients with ACSC call or are referred to EMS for the new MCT service. Given that MCT patients were less likely to have a primary care provider this may represent an increase in access to care, or a shift away from other emergency/episodic care. These associations must be further studied to inform the ideal utility of adding such services to EMS and healthcare systems.

scholarly journals The Role of Emergency Medical Services in Geriatrics: Bridging the Gap between Primary and Acute Care

CJEM ◽  
2015 ◽  
Vol 18 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Judah Goldstein ◽  
Jennifer McVey ◽  
Stacy Ackroyd-Stolarz
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Emergency Medical Services ◽  
Acute Care ◽  
Functional Independence ◽  
Adverse Outcomes ◽  
Medical Services ◽  
Care Needs ◽  
Frail Older Adults ◽  
Emergency Medical

AbstractCaring for older adults is a major function of emergency medical services (EMS). Traditional EMS systems were designed to treat single acute conditions; this approach contrasts with best practices for the care of frail older adults. Care might be improved by the early identification of those who are frail and at highest risk for adverse outcomes. Paramedics are well positioned to play an important role via a more thorough evaluation of frailty (or vulnerability). These findings may inform both pre-hospital and subsequent emergency department (ED) based decisions. Innovative programs involving EMS, the ED, and primary care could reduce the workload on EDs while improving patient access to care, and ultimately patient outcomes. Some frail older adults will benefit from the resources and specialized knowledge provided by the ED, while others may be better helped in alternative ways, usually in coordination with primary care. Discerning between these groups is a challenge worthy of further inquiry. In either case, care should be timely, with a focus on identifying emergent or acute care needs, frailty evaluation, mobility assessments, identifying appropriate goals for treatment, promoting functional independence, and striving to have the patient return to their usual place of residence if this can be done safely. Paramedics are uniquely positioned to play a larger role in the care of our aging population. Improving paramedic education as it pertains to geriatrics is a critical next step.

scholarly journals Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

2019 ◽  
Author(s):  
Linda Huibers ◽  
Anders H Carlsen ◽  
Grete Moth ◽  
Helle C Christensen ◽  
Ingunn S Riddervold ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Medical Services ◽  
Healthcare Service ◽  
Service Providers ◽  
Patient Characteristics ◽  
Medical Services ◽  
Cross Sectional ◽  
Out Of Hours ◽  
Emergency Medical ◽  
Acute Healthcare

Abstract Background Patients in need of acute healthcare do not always contact the most suitable healthcare service provider. Contacting out-of-hours primary care for an urgent problem may delay care, whereas contacting emergency medical services for a non-urgent problem could ultimately affect patient safety. More insight into patient motives for contacting a specific healthcare provider may help optimise patient flows. This study aims to explore patient motives for contacting out-of-hours primary care and the emergency medical services in Denmark. Methods We conducted a cross-sectional observational study by sending a questionnaires to patients contacting out-of-hours primary care and emergency medical services, both of which can be directly contacted by patients, in two of five Danish regions in 2015. As we aimed to focus on the first access point, the emergency department was not included. The questionnaire included items on patient characteristics, health problem and 26 pre-defined motives. Descriptive analyses of patient characteristics and motives were conducted, stratified by the two healthcare service providers. Factors associated with contacting each of the two service providers were explored in a modified Poisson regression analysis, and adjusted risk ratios were calculated. Results Three key motives for contacting the two service providers were identified: ‘unpleasant symptoms’, ‘perceived need for prompt action’ and ‘perceived most suitable healthcare provider’. Other important motives were ‘need arose outside office hours’ and ‘wanted to talk to a physician’ (out-of-hours primary care) and ‘expected need for ambulance’ and ‘worried’ (emergency medical services). Higher probability of contacting the emergency medical services versus out-of-hours primary care was seen for most motives relating to own assessment and expectations, previous experience and knowledge, and own needs and wishes. Lower probability was seen for most motives relating to perceived barriers and benefits. Conclusions Patient motives for contacting the two healthcare service providers were partly overlapping. The study contributes with new knowledge on the complex decision-making process of patients in need of acute healthcare. This knowledge could help optimise existing healthcare services, such as patient safety and the service level, without increasing healthcare costs.

scholarly journals Development of a Unique Student Pharmacist Internship in a Primary Care Provider System

Pharmacy ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 36
Author(s):  
Norman E. Fenn ◽  
Natalie R. Gadbois ◽  
Gwen J. Seamon ◽  
Shannon L. Castek ◽  
Kimberly S. Plake
Keyword(s):  
Primary Care ◽  
Inventory Management ◽  
Nurse Practitioners ◽  
Care Provider ◽  
Primary Care Provider ◽  
Assistance Program ◽  
North Central ◽  
The North ◽  
Contraceptive Devices ◽  
One Year

Purpose: To describe a unique pharmacy intern program in a group of federally qualified health center (FQHC) outpatient primary care provider clinics. Summary: A pharmacy intern program was created at the North Central Nursing Clinics in Indiana, a group of four FQHC outpatient primary care provider facilities. Intern-performed tasks included: Prior authorization (PA) requests, medication assistance program (MAP) applications, sample procurement and inventory, and contraceptive devices for implantation inventory management. Interns interacted with clinic administration, nurse practitioners, and medical staff to complete their assigned responsibilities. Over a one-year period, the interns completed documentation on more than 2000 charts during a combined 12 h a week. Interns identified the interprofessional interactions as the most beneficial experience, while providers acknowledged no difference in the processing of paperwork during the transition of duties from pharmacy fellow to intern. Conclusion: This unique pharmacy intern program was successfully created and implemented in a primary care provider office, resulting in learning opportunities for pharmacy interns, as well as operational efficiencies to fellows, providers, and the organization.

scholarly journals Sociodemographic Characteristics Associated with Contacts to Emergency Medical Services and Out-of-Hours Primary Care: An Observational Study of 2.3 Million Citizens

2020 ◽  
Vol Volume 12 ◽  
pp. 393-401
Author(s):  
Morten Breinholt Søvsø ◽  
Bodil Hammer Bech ◽  
Helle Collatz Christensen ◽  
Linda Huibers ◽  
Erika Frischknecht Christensen ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Sociodemographic Characteristics ◽  
Out Of Hours ◽  
Emergency Medical

scholarly journals Psychological Resilience towards COVID-19 amongst Emergency Medical Professionals in Pune (India)

2021 ◽  
pp. 17-24
Author(s):  
Parag Rishipathak ◽  
Shrimathy Vijayraghavan ◽  
Anand Hinduja
Keyword(s):  
Emergency Medical Services ◽  
Well Being ◽  
Medical Services ◽  
Medical Professionals ◽  
Psychological Resilience ◽  
Breaking Bad ◽  
Stressful Environment ◽  
Emergency Medical ◽  
Work Routine ◽  
One Year

Aim: The surge of COVID 19 infection across the globe has put tremendous pressure on Healthcare Professionals worldwide. Emergency Medical Professionals are first responders and hence bear the brunt of exposure to the virus as well as dealing with critically ill patients. The aim of the study is to assess psychological resilience towards COVID 19 amongst Emergency Medical Professionals. Study Design: Descriptive Study. Place and Duration of Study: Symbiosis Centre for Health Skills, Pune in April 2021. Methodology: The study was conducted amongst 120 Emergency Medical Professionals in Pune, India. The data was collected during the month of April 2021. Professionals who have completed Post Graduate Diploma in Emergency Medical Services and working in COVID centres for at least one year were included in the study. A 38-item questionnaire was developed for frontline Emergency Medical Professionals and included questions adapted from the tools which are available in public domain. Results and Discussion: Working in a stressful environment along with continuous fear of self-exposure and risk of transmission to family members affects the efficacy and productivity of Emergency Medical Services Professionals. Debriefing, training for effective ‘breaking bad news’ stress management workshops and counselling sessions should be integrated into their work routine to enhance their psychological capacity. Conclusion: The findings indicate that even after a year of serving COVID 19 patients, Emergency Medical Professionals demonstrate a high degree of resilience. Yet there are areas requiring improvement which need to be focussed upon immediately in the interest of the mental well-being of Emergency Medical Professionals.

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