Paramedic assessment of older adults after falls, including community care referral pathway: cluster randomized trial

Snooks, Helen A. and Rebecca, Anthony and Robin, Chatters and Jeremy, Dale and Fothergill, Rachael T. and Gaze, Sarah and Halter, Mary and Humphreys, Ioan and Koniotou, Marina and Logan, Phillipa and Lyons, Ronan A. and Mason, Suzanne and Nicholl, Jon and Peconi, Julie and Phillips, Ceri and Porter, Alison and Siriwardena, A. Niroshan and Wani, Mushtaq and Watkins, Alan and Wilson, Lynsey and Russell, Ian T. (2017) Paramedic assessment of older adults after falls, including community care referral pathway: cluster randomized trial. Annals of Emergency Medicine, 70 (4). pp. 495-505. ISSN 0196-0644

Full content URL: http://www.annemergmed.com/article/S0196-0644(17)3...

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Paramedic Assessment of Older Adults After Falls, Including Community Care Referral Pathway: Cluster Randomized Trial
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Abstract

Study objective
We aim to determine clinical and cost-effectiveness of a paramedic protocol for the care of older people who fall.

Methods
We undertook a cluster randomized trial in 3 UK ambulance services between March 2011 and June 2012. We included patients aged 65 years or older after an emergency call for a fall, attended by paramedics based at trial stations. Intervention paramedics could refer the patient to a community-based falls service instead of transporting the patient to the emergency department. Control paramedics provided care as usual. The primary outcome was subsequent emergency contacts or death.

Results
One hundred five paramedics based at 14 intervention stations attended 3,073 eligible patients; 110 paramedics based at 11 control stations attended 2,841 eligible patients. We analyzed primary outcomes for 2,391 intervention and 2,264 control patients. One third of patients made further emergency contacts or died within 1 month, and two thirds within 6 months, with no difference between groups. Subsequent 999 call rates within 6 months were lower in the intervention arm (0.0125 versus 0.0172; adjusted difference –0.0045; 95% confidence interval –0.0073 to –0.0017). Intervention paramedics referred 8% of patients (204/2,420) to falls services and left fewer patients at the scene without any ongoing care. Intervention patients reported higher satisfaction with interpersonal aspects of care. There were no other differences between groups. Mean intervention cost was $23 per patient, with no difference in overall resource use between groups at 1 or 6 months.

Conclusion
A clinical protocol for paramedics reduced emergency ambulance calls for patients attended for a fall safely and at modest cost.

Keywords:paramedic, falls, older people, community care referral pathway, ambulance, ambulance services
Subjects:B Subjects allied to Medicine > B160 Physiotherapy
B Subjects allied to Medicine > B930 Occupational Therapy
B Subjects allied to Medicine > B780 Paramedical Nursing
A Medicine and Dentistry > A300 Clinical Medicine
Divisions:College of Social Science > School of Health & Social Care
ID Code:26722
Deposited On:14 Mar 2017 19:39

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