Extending Cardiovascular Care Beyond the Clinic: Evaluation of a Community Paramedicine Program to Support Patients with Medical Complexity

Problem: Health care systems, especially acute care settings, are becoming overburdened with patients who are older, have medical complexity, and have limited access to health care resources. Community paramedicine (CP) programs use paramedics to offer preventive care, health education, and connections with the community that is underserved and experiencing homelessness. CP programs have emerged to reduce acute care utilization and emergency department visits, and to improve health care outcomes. Approach: A local CP team was paired with the MaineHealth cardiovascular disease fellows' clinic to expand cardiovascular care to patients at high risk. Individuals were identified by clinicians as requiring additional support and were referred for home visits with the CP team. Information collected included patient demographics, medical history, reason for the encounter, psychosocial barriers to care, emergency department visits, and medication discrepancies. A descriptive analysis was then completed to characterize the patient population, describe services provided, and evaluate the impact on patient health care utilization. Outcomes: Over 1 year, the CP program visited 156 patients with a median age of 70 years. Patients often had multiple reasons for a visit, including medication management and reconciliation (65%); vital sign measurement, such as blood pressure measurement (85%); and clinical assessment for heart failure (45%). The most common cardiac conditions encountered were diastolic and systolic heart failure (60%). Common social barriers to care included lack of transportation, language barriers, food insecurities, and unstable housing or homelessness. The CP program facilitated wearable cardiac rhythm monitors, phlebotomy collection, wound checks, and health education. Next Steps: CP programs are an additional resource to cardiovascular care beyond the traditional clinic setting and may help address medical and social barriers in patients at high risk. Further research must be completed to analyze the long-term impact and safety of CP programs on patient care and hospitalizations.