Canadian Expanding Paramedicine in the Community (EPIC) Study Concludes, Program Remains

When enrolled Grey County patients, community paramedics and officials reached the end of an “Epic” pilot study on the value of in-home healthcare, they were so impressed with the program that it was extended past its original study period.

Grey County Paramedic Services, the Owen Sound Family Health Team (FHT) and St. Michael’s Hospital in Ontario, Canada, teamed up for the Expanding Paramedicine in the Community (EPIC) study that sought to determine how effective community paramedics could be in reducing emergency department visits and hospital admissions by patients with chronic disease.

“Too often, patients with a chronic condition end up in the hospital or worse from symptoms that could be identified and treated by a community paramedic,” says Mike Muir, director of Paramedic Services with Grey County. “Our community paramedics can save patients unnecessary suffering and trips to the emergency room by checking in regularly and catching symptoms early.”

The trial period lasted from January 1, 2015 through November of that year monitoring and treating patients in three groups of chronic conditions—diabetes mellitus (DM), congestive heart failure (CHF) and chronic obstructive pulmonary disorder (COPD).

EPIC was paid for by one-time funding of C$300,000 dollars provided by the Ministry of Health and Long-Term Care.

Patient Enrollment and Practice

Through the EPIC program, two primary care paramedics—Rick Trombley and Scott Luce—were reassigned and trained for eight weeks at Centennial College as community paramedics, a designation that greatly increases the treatments they could administer through consultation with their patients’ physicians.

The FHT worked closely with the Grey County community paramedics (CP) to enroll patients and administer the trial. Qualifying patients, those with at least one chronic condition named in the study, were contacted by FHT and requested to join. The goal was to enroll 200 patients.

“We were pleased with the response to the invitation letter, but would have like to have seen a little better response. We originally enrolled 155 patients in total—76 in the interventional group and 79 in the control group,” says Muir.

Eventually, the three groups of patients in the study included 46 with DM, 65 with COPD and 49 with CHF. A total of 52 patients had co-morbidities and three had all three chronic conditions.

“We found the adjustment from emergency response to chronic disease management challenging. The CPs adjusted well and were able to incorporate their new skill set within a few months. The new relationship with the primary care practitioners was also a challenge since we haven’t had this relationship in the past, and the need to build trust between practitioners and CPs did take some time,” explains Muir. “CPs also develop personal relationships with the patients, which was somewhat foreign because most emergency calls end after the patient is transferred to the receiving facility. The death of a study patient had a greater emotional impact on the CPs.”

Outcomes and Lessons Learned

Data was collected confidentially throughout the study for analysis by a third party. Results will be used to help determine the effectiveness of community paramedicine in this setting, but are not yet available.

“We have had great results from a patient satisfaction standpoint. Patients have responded well to the program and believe that it’s improved their overall health and well-being,” says Muir.

Study coordinators are awaiting the analysis of the data by clinical investigators, which is expected to be completed by this summer. The timing is based on accessing hospital data to allow for full analysis, particularly the control group’s hospital utilization.

What Now?

“We’ve received additional funding post-study to continue with the program until March 31, 2017, because the Ministry of Health would like further evaluation,” says Muir.

Muir adds that Grey County continues seeking other ways to fund community paramedicine and is looking to partner with other healthcare providers.

“We’ve been fortunate to be part of the EPIC study,” says Muir. “It’s been clear since day one of the trial that community paramedicine benefits patients in Grey County. We believe the EPIC program will transform the landscape for chronic disease management in the community.”

Grey County community paramedics are also participating in Remote Patient Monitoring (RPM), where they have installed B/P, pulse ox, scales and glucometers for non-EPIC patients enrolled in a different program. Patients in this program are monitored remotely for anomalies in their vital signs. They are currently enrolling the EPIC patients in the RPM program to see if earlier intervention will improve their health status.