Older people make up to 21% of visits to hospital emergency departments and previous studies have suggested that paramedics can be trained to manage certain conditions in the community. But current research evidence concerning safety, effectiveness and costs to support these changes in practice is lacking.
So researchers based in South Yorkshire carried out the first randomised trial to evaluate the effectiveness of an alternative approach to managing older people with minor problems.
They selected seven experienced paramedics who had completed the Paramedic Practitioner in Older People's Support (PPOPS) training course. This scheme aims to deliver patient centred care to older people calling the emergency services with conditions judged to be not immediately life threatening.
The trial took place in Sheffield from September 2003 to September 2004 and included 3,018 patients aged 60 years and above calling the emergency services between 0800-2000hrs with a complaint that fell within the scope of practice of the paramedic practitioners. These included falls, lacerations, nosebleeds or minor burns.
During each week, a paramedic practitioner based in the ambulance control room identified eligible calls and notified either a paramedic practitioner in the community (intervention weeks) or in the emergency department for the standard 999 service (control weeks).
Emergency department attendance or hospital admission between 0 and 28 days was recorded, as was interval from time of call to time of discharge. Patient satisfaction with the service they had received was also measured using a postal questionnaire 3 and 28 days after the incident.
Patients in the intervention group were almost 25% less likely to attend the emergency department or require hospital admission within 28 days. These patients also experienced a shorter total episode time by around 42 minutes.
Patients in the intervention group were also more likely to report being highly satisfied with their health care episode than those in the control group.
There were no statistically significant differences between the two groups in terms of health outcomes and mortality 28 days after their initial episode.
Despite some study limitations, the authors conclude that this service conveyed significant benefits for patients and the NHS in terms of reduced overall emergency department and hospital attendances, shorter episode times and higher levels of patient satisfaction. The new service also appears to be safe in that they identified no difference in mortality or health outcomes after 28 days.
As pressure increases within the NHS to extend this type of approach, this trial will help to inform practice in this fast developing area, they add.
This trial shows that high quality study designs are feasible in this setting, says an accompanying editorial. Such trials should, therefore, be used to evaluate the more widespread emergency care practitioners scheme and other extended scope paramedic programmes before further costly expansions take place.