Evidence map›Paper›PMID 39587610›Full record

Trial reportBMC health services research2024

Effectiveness of the community paramedicine at home (CP@home) program for frequent users of emergency medical services in Ontario: a randomized controlled trial.

Gina Agarwal, Ricardo Angeles, Jasdeep Brar, Melissa Pirrie, Francine Marzanek, Brent McLeod, Lehana Thabane

Registry-linked trialAbstract readRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC health services research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02835989 (Community Paramedicine at Home), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02835989 nacompletednot on this map

Community Paramedicine at Home (CP @Home)

TypeinterventionalSponsorMcMaster UniversityRan2018 to 2021Enrolled2,826ConditionsCardiovascular Disease, Diabetes Mellitus, Accidental Falls, Social IsolationArmsCP@Home
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Gina AgarwalDepartment of Family Medicine, McMaster University, Hamilton, ON, Canada. gina.agarwal@gmail.com.
Ricardo AngelesDepartment of Family Medicine, McMaster University, Hamilton, ON, Canada.
Jasdeep BrarDepartment of Family Medicine, McMaster University, Hamilton, ON, Canada.
Melissa PirrieDepartment of Family Medicine, McMaster University, Hamilton, ON, Canada.
Francine MarzanekDepartment of Family Medicine, McMaster University, Hamilton, ON, Canada.
Brent McLeodHamilton Paramedic Services, Hamilton, ON, Canada.
Lehana ThabaneDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

Funding

CIHR FRN 152951
6 · The paper itself

Abstract

objectiveTo evaluate the impact of the Community Paramedicine at Home (CP@home) program, a community paramedicine home-visit intervention, on reducing emergency medical services (EMS) calls among frequent users.

designA 6-month, open-label, pragmatic, randomized controlled trial with parallel intervention and control arms. An online automated platform (randomizer.org) was used to randomly allocate participants using a 1:1 allocation sequence.

settingIn homes of frequent EMS users in four paramedic services and regions across Ontario, Canada.

participantsEligible participants were frequent callers (≥ 3 EMS calls within six months and ≥ 1 EMS call within the previous month), or had ≥ 1 lift assist call within the previous month, or were referred by paramedics.

interventionCommunity paramedics conducted risk assessments, provided health education, referred appropriate resources, and reported to family physicians for up to three home visits. The control arm received usual care. PRIMARY OUTCOME MEASURE: EMS calls in 6 months during intervention.

resultsTwo thousand two hundred eighty four eligible participants were randomly allocated to the intervention and control groups, with 265 participants lost to follow-up due to inability to retrieve participant records from EMS databases. There were 1025 intervention participants (52.7% female, mean age 69.65 years [standard deviation (SD) = 19.98]) and 994 control participants (52.0% female, mean age 69.78 years [SD = 19.09]). In the post-intervention intention-to-treat analysis (zero-inflated negative binomial regression), the EMS call rate was not significantly lower in the intervention group compared to the control group (incidence rate ratio [IRR] = 0.88, 95% confidence interval [CI]: 0.76, 1.01). In the subgroup analysis, the intervention had a significant effect in the lift assist caller subgroup (IRR = 0.73, 95% CI: 0.58, 0.92), but no significant effect among the frequent caller subgroup (IRR = 0.97, 95% CI: 0.82, 1.14). The sensitivity analyses found a similar association for the lift assist caller subgroup. There was a significant subgroup effect (p-value for interaction < 0.01).

conclusionsCP@home had a significant impact on reducing EMS calls for those with a lift assist call but not for the overall sample. This program filled a healthcare gap by shifting primary care delivery, which could reduce the disproportionate number of EMS calls, thus reducing healthcare costs.

trial registrationRegistered with ClinicalTrials.gov NCT02835989 on July 14, 2016.

Indexed as

Emergency Medical ServicesAdultAgedAllied Health PersonnelCommunity Health ServicesFemaleHome Care ServicesHouse CallsHumansMaleMiddle AgedOntarioParamedicineProgram EvaluationCommunity paramedicineEmergency medical servicesFrequent callersLift assist callersRandomized controlled trial

Identifiers

PMID39587610
PMCPMC11590269

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.