The number of patients preferring in-home care as opposed to obtaining treatment at a hospital is on the rise (1). Patients receiving palliative treatment also prefer home-based care as three-quarters have expressed a desire to die in their homes (1). However, those receiving palliative treatment often do so in a hospital setting as measures to provide such treatment at home are not widely available. Hospice and palliative care services being provided solely by hospital settings is unsustainable (2). To meet the growing demand for palliative care and to decrease palliative hospital admissions, community paramedicine (CP) is a multidisciplinary approach to palliative care that offers palliative care to patients at their homes through paramedics (3).
Until recently, the scope of practice for paramedics was limited to providing acute life-sustaining treatment and transportation to a hospital (4). Community paramedicine is a novel approach to palliative care that allows paramedics to provide community-based care including crisis and symptom management within the patient’s home, thereby reducing visits to emergency departments (5). CP care is tailored to bridge the gaps between the requirement and access to care by bringing the required services to the patient’s home. Pilot CP programs have been launched across Canada and have highlighted the benefits of paramedics providing palliative care which results in increased patient satisfaction (5).
Several community paramedicine programs have been launched to evaluate the efficacy of paramedic-led palliative care in Ontario. One specific program reported a 41% reduction in hospital readmission followed by paramedics providing palliative care services (6). Similarly, an evaluation of a CP program in Hamilton, Ontario showcased a significant decrease in monthly ambulance calls for palliative care-related services (7). Proponents of paramedic-led palliative care argue that there exists a gap between the need and delivery of palliative care and this gap can be bridged through community paramedicine programs. A study conducted by Carter et al. examined the satisfaction levels of patients and their family members with the delivery of paramedic-led palliative care and found that such a program provided patients and their family members with peace of mind (8).
Community paramedicine pilot programs are prevalent across Canada and utilize the diverse skillsets of paramedics to rapidly assess patients and provide the appropriate treatment (5). A CP pilot program launched in Nova Scotia showcased that paramedics were able to prevent 55% of avoidable hospital visits (8). Additionally, this program also revealed a high degree of satisfaction among patients and caregivers (8). Patients receiving palliative treatments at home demonstrated feelings of gratitude in being able to receive services at home, resulting in significantly less distress (8). Similar pilot programs have been conducted in Nova Scotia, Alberta, and Prince Edward Island where patients received urgent palliative care treatment in their homes (9). Results of the program showcased increased hospital avoidance, improved patient and caregiver quality of life, and rapid symptom management (9).
Wherever patients and caregivers chose to receive palliative treatment, they deserve access to high-quality and effective care. With increased investments in community paramedicine programs, the delivery of palliative care can be brought to the patient’s home. With proper training, paramedics possess the ability to address patients’ palliative needs in their homes, thereby honoring patient and caregiver wishes and avoiding unnecessary hospital visits.
- Canadian Institute for Health Information. Access to Palliative Care in Canada. Ottawa, ON: CIHI; 2018.
- Sullender, R. T., & Selenich, S. A. (2016). Financial Considerations of Hospital-Based Palliative Care. RTI Press. http://www.ncbi.nlm.nih.gov/books/NBK532652/
- Organization, W. H. (2020, August 5). Palliative care. https://www.who.int/news room/fact-sheets/detail/palliative-care
- O’Hara, R., Johnson, M., Siriwardena, A. N., Weyman, A., Turner, J., Shaw, D., Mortimer, P., Newman, C., Hirst, E., Storey, M., Mason, S., Quinn, T., & Shewan, J. (2015). A qualitative study of systemic influences on paramedic decision making: Care transitions and patient safety. Journal of Health Services Research & Policy, 20(1_suppl), 45–53. https://doi.org/10.1177/1355819614558472
- Rosa, A., Dissanayake, M., Carter, D., & Sibbald, S. (2022). Community paramedicine to support palliative care. Progress in Palliative Care, 30(1), 11–15. https://doi.org/10.1080/09699260.2021.1912690
- Johnston, C., Carter, D., & Batt, A. (2018). Keeping them on their feet: Novel solutions to the emerging lift assist trend. Faculty & Staff Publications – Public Safety. https://first.fanshawec.ca/fhcsps_publicsafety_facultystaffpublications/25
- Agarwal, G., Pirrie, M., McLeod, B., Angeles, R., Tavares, W., Marzanek, F., & Thabane, L. (2019). Rationale and methods of an Evaluation of the Effectiveness of the Community Paramedicine at Home (CP@home) program for frequent users of emergency medical services in multiple Ontario regions: A study protocol for a randomized controlled trial. Trials, 20(1), 75. https://doi.org/10.1186/s13063-018-3107-4
- Carter, A. J. E., Arab, M., Harrison, M., Goldstein, J., Stewart, B., Lecours, M., Sullivan, J., Villard, C., Crowell, W., Houde, K., Jensen, J. L., Downer, K., & Pereira, J. (2019). Paramedics providing palliative care at home: A mixed-methods exploration of patient and family satisfaction and paramedic comfort and confidence. CJEM, 21(4), 513–522. https://doi.org/10.1017/cem.2018.497
- Canadian Foundation for Healthcare Improvement. Better how? Innovating to transform healthcare for Canadians. CFHI Annual Report 2016–2017. 2017. Available from: https://www.cfhi-fcass.ca/docs/default-source/about-us/corporate-reports/cfhi-annual-report-2016-2017-e.pdf?sfvrsn=e84ed593_2