When paramedics visit seniors, emergency room trips go down


Above: paramedic Joe Cox takes the blood pressure of Cyril Hunt at a CHAP EMS clinic. According to a new program led by associate professor Dr. Gina Agarwal, EMS staff may be effective in preventing emergencies with weekly visits to patients at risk for cardiovascular disease, diabetes and falls.

A McMaster-led pilot project has found that weekly visits by two paramedics to a seniors’ home cuts EMS calls by up to a third.

The study was presented last weekend at the Canadian Cardiovascular Congress by Dr. Gina Agarwal, associate professor in the Department of Family Medicine of the Michael G. DeGroote School of Medicine.

Agarwal led the Cardiovascular Health Awareness Program (CHAP) EMS pilot project at a subsidized housing complex in Hamilton with about 280 residents, predominantly low income seniors. It’s a group at increased risk of cardiovascular disease, diabetes and falls, and local EMS receives frequent calls from the building.

Two paramedics provided weekly drop-in sessions to review healthy lifestyles, measure blood pressure, assess diabetes risk and risk of falls.

Preliminary data shows a trend of up to 32 per cent reduction in EMS calls from the single building in which the program was offered since the sessions began.

“As members of the health team on the front line, paramedics can play a valuable role in reducing the risk and improving the health of seniors,” said Agarwal.

Over eight months, 56 residents — 25 per cent of residents over age 65 — made more than 580 visits to the EMS session. More than 60 per cent of the residents who attended the sessions had an elevated body mass index, 40 per cent reported a low level of physical activity, one-third smoked, one-third had a high salt intake, one-third had a high fat intake and 50 per cent had high blood pressure.

Of the residents with high blood pressure, 80 per cent were already on medication for it. With their permission, the readings taken at the sessions were conveyed to their family doctor, who could then take action like adjusting medication.

“At each visit the paramedics discussed one or two risk factors, such as smoking, diet or lack of exercise; tried to link residents to community resources and give advice, and then followed up to see how residents were managing,” said Agarwal.

Paramedics made many referrals to the in-house wellness exercise program; a diabetes foot care and education program; family doctors and linked seniors with community food advisors and the quit smoking line.

“With their regular presence thanks to the weekly schedule, the paramedics seem approachable,” explained Agarwal. “The number of new attendees keeps rising with word of mouth. The high number of multiple visits also indicates a hunger for this type of health information when it’s so readily available.

“Residents value the time that they spend at the clinic, and build a trusting relationship because they know that the paramedics are highly trained professionals who are knowledgeable and compassionate,” said Brent McLeod, superintendent of education for Hamilton Paramedic Services.  “It is also an opportunity for paramedics to keep in contact with patients. This project truly is a preventative model which is in line with the goals of the Local Health Integration Network.”

Dr. Beth Abramson, spokesperson for the Heart and Stroke Foundation said: “Communication is the key here. Discussing preventive behaviours and making the advice accessible is important for people all age groups and backgrounds.

“Community-based health programs like this can be a very effective way to promote good health and prevent chronic conditions. We can all learn from this experience.”

Agarwal says the study will follow-up to assess whether the risk profile of the session attendees has evolved.

The study was carried out by the Department of Family Medicine of the Michael G. DeGroote School of Medicine, in collaboration with Hamilton Paramedics Service, Public Health Services for the City of Hamilton, CityHousing Hamilton and the Hamilton Community Care Access Centre.