Healthcare Professionals and Healthcare

Community Paramedicine

When it comes to healthcare in the United States, there are a number of challenges and issues that challenge everyday Americans all of the time. The common refrains are access to providers, costs and so forth. However, the devised and proposed solutions are also gaining prominence as well. One such solution has come to be known as community paramedicine. The key to community paramedicine is that emergency management services (EMS) personnel act outside of and beyond their traditional scope of duties and responsibilities. This is done as a means to enhance and improve the healthcare options that exist within the communities. This report is meant as a review and summary of the use of community paramedicine and how it can be created and expanded in the state of Maryland. While the community paramedicine methodology is still very much in its nascent stages, the potential benefits and better outcomes for all serves as more than a motivation to expand its usage.

Analysis

As noted in the introduction, the literature review that follows in this report shall serve as a justification for creating and expanding the use of community paramedicine in Maryland. This would include all urban centers and larger cities such as Baltimore and Annapolis but should also include other areas of the state that would obviously benefit from community paramedicine and/or have an urgent need for the services and benefits provided by the same. Even rural areas have been shown to benefit from community paramedicine. Further, some of those areas are not entirely far from Maryland or even the United States in general. Indeed, the use of community paramedicine has been used in rural Ontario up in Canada. When it comes a rural setting, any community paramedicine program in Maryland should have four major components. Those components are ad hoc home visiting, aging at the home, paramedic wellness clinics and having a proper and robust community paramedic response unit. While there may be more acclimated to fishing posts and such in states like Alaska, there are surely at least some situations and people within the Maryland area that would be classified as rural areas given the lack of healthcare access and other issues. As such, focusing on the healthcare needs of such residents and the consumer satisfaction levels of those same people should be of paramount importance and attention (Martin, O'Meara & Farmer, 2016).

Another dimension that cannot typically be ignored or disregarded when it comes to community paramedicine is the demographic mix of the people being served. This can absolutely be applied to the rural setting just referenced. However, it can and should also be applied to areas where racial minorities are the norm. Indeed, Maryland absolutely has areas such as Baltimore and others where the population of African-Americans is high. Given that African-Americans, for example, only represent 13% or so of the national population, this has to be something that is focused on. Beyond that, racial minorities tend to have healthcare access and quality issues and/or they are at higher risk than the average white male in the population. Poverty tends to be a major reason for this but there would seem to be other factors as well. Regardless, community paramedicine is a way to address this problem head on via the means of having EMS-trained professionals on hand to give services that are both emergency and proactive in nature. Indeed, treating someone for a breathing issue is important but so is educating and helping people when it comes to the management and handling of their type II diabetes. Getting the people in a community and the community as a whole engaged in that whole process is a huge part of changing the paradigm and getting the culture and neighborhoods as a whole on the right track in terms of health and being proactive about the same (O'Meara, Stirling, Ruest & Martin, 2016).

While having EMS staff in the mix is a linchpin and cornerstone of the community paramedicine model, there are a few other types of personnel and people that must be involved as well. Due to regulatory and other legal reasons, one such person would be a pharmacist. Indeed, EMS people are able to provide life-saving treatments and medicine in the field when an emergency calls for it. However, providing medicinal and pharmacological solutions above and beyond such urgent situations is definitely restricted. For example, treating someone with extremely low blood sugar is one thing and EMS personnel would assist with that. However, managing that blood sugar after EMS and/or the hospital has done their thing would also be important and EMS cannot do that on their own. For that to happen, an endocrinologist or other qualified physician would need to assess what is going on and that person would prescribe medicine. Upon this being completed, a pharmacist would dispense the medicine (Crockett et al., 2016).

As such, this would show that any community paramedicine may very well be dominated by EMS personnel. However, there will be some doctors and other medical professionals like pharmacists involved as well. This is due to legal and regulatory constraints and it can also serve as a check and balance so as to ensure that everything is staying within their proverbial lane from a legal and guidance standpoint. What makes the community medicine paradigm so much different from the more conventional and traditional models that this all happens within is that home visits and monitoring can be much more advanced and protracted as compared to what is normally and practical. Indeed, patients that have heart failure are at high risk of dying or at least having further complications. However, such patients getting to a doctor or emergency room can be rather hard to pull off. This is where an expanded community paramedicine framework can come in hand and indeed save or at least extend lives in some to many instances (Crockett et al., 2016).

Another facet of community paramedicine that has to be part of any modernized and proper solution is the use of mobile technology. At the same time, there is a lot of valid concern when it comes to the security and quality of such mobile solutions. Whether it be privacy, access or what have you, any mobile solutions deployed for community paramedicine need to be done properly, completely and securely so that they work for the intended purpose and give access to those that require and need it...but nothing beyond that. Just as the emergency management services people involved in community paramedicine are used to fill in "gaps" in healthcare access and quality in the communities, the use of mobile technology can be used to address the same when it comes to areas and situations where access to healthcare and patient information is not as easy or possible as it would be in a doctor's office or hospital (Choi, Blumberg & Williams, 2016).

When it comes to mobile healthcare solutions of any sort, there are a few overarching and obvious concerns that may or may not involve the legal or regulatory paradigm. Regardless, any people involved in creating or expanding the community paramedicine options in Maryland need to take note. These concerns include efficacy, safety and cost-effectiveness. If done properly, a mobile data system for community paramedicine professionals could limit and mitigate things like readmissions due to congestive heart failure, reduce the number of patients that have to be frequently transported by EMS personnel and the amount of emergency department visits overall. It has to be admitted and stated up front that the body of knowledge when it comes to all of this is not as complete or resounding as it could be. Even so, the basics are firmly falling into place and this would include the legal and regulatory aspects of the community paramedicine practice, both within and outside of the state of Maryland (Choi, Blumberg & Williams, 2016).

Even with the above, the rather nascent nature of the community paramedicine paradigm requests and requires that people assess these new or at least newer questions that exist. Indeed, community paramedicine is already clearly addressing particular things that sometimes involve legal issues but also involve issues that involve ethics, what people are entitled to and what should be the deliverables of a healthcare system or any part thereof. As touched upon already, just some of the things that community paramedicine is meant to address would include insufficient access to primary medical care sources, the avoidance of using urgent care networks due to the higher costs involved and so forth. However, there are seemingly ancillary things that must also be addressed such as the training for the involved EMS personnel, the testing of competencies for those same personnel and the job satisfaction of all of the paramedicine employees involved (Iezzoni, Domer & Ajayi, 2016). Something that is taking some shape of its own is patient-centric care. Indeed, many studies and reviews of the topic, including that of some community paramedicine efforts in Montgomery County, Texas, have proven that the patients involved in the practice of paramedicine need to be the primary focus of the care and the quality thereof. Indeed, helping patients that are at risk and vulnerable in general are the main focal point of community paramedicines initiatives and plans. There are many patients that have access to the primary care resources that they need and thus they are not the focus of community paramedicine programs and the funding for the same (Clark, Gleisberg, Karrer & Escott, 2015).

Even with the fact that community paramedicine is generally accepted as being a tool in the proverbial toolbox to assist in fixing the problems and inequities that exist within the United States healthcare system, there can and should be a tool use to keep an eye on customer satisfaction and the mobile access quality that exists. In the United States, this has already been created and used in the form of what is known as the mobile integrated healthcare and community paramedicine (MIH-CP) national survey. The publication EMS World published a review and summary of that survey in a treatise that came out in 2015 (EMS World, 2015).

Something else that the Maryland expansion and creation of the community paramedicine program is the qualitative study of participants view on the role of paramedics. Precisely that was part of a study done just a few months ago as it related to the CHAP-EMS health promotion program. Indeed, as there is a sharp evolution and change of what a "standard" EMS professional does, there also needs to be a tracking of how those EMS professionals are perceived and welcome when it comes to their expanded or changed roles. Prior work along these lines has pointed to three overarching and important themes. They include the use of paramedics as health advocates, the existence and presence of caring and trusting relationships and the added value of EMS skills in this new and expanded role that they are inhabiting. All of this is based on on-the-ground experiences with EMS professionals that are working in the proverbial trenches. Even if the paradigm and common environments are fairly new, at least to the people involved, it needs to be assessed whether the community paramedicine paradigm is taking shape in the best ways. Also important, as is the theme of much of this report, are the legal and regulatory concerns and hurdles that might or definitely exist along the way. Even with that, the feelings and reactions of the patients and other people around the same is no less important to focus on. It can be difficult to properly and fully measure these things as qualitative responses and outcomes are much harder to track and show patterns for than quantitative measures. Even so, they are not irrelevant and must be part of any data collection completed during studies of community paramedicine programs and initiatives. Just because something is hard to measure does not mean it cannot be measured or should not be measured. The stated and open-ended responses of the patients and families of the same must be listened to so as to spot issues and perfect the models and methods used (Brydges, Denton & Agarwal, 2016).

Even though qualitative measures are a huge and important part of creating and expanding paramedicine efforts in Maryland, the use of quantitative measures can still be effective and scientific in nature. This can and should include the measure of legal and regulatory concerns when it comes to community paramedicine regardless of where it is happening and/or that it is studied. One such prior study that proves this and then some would be the EPIC survey that was done in Toronto, Canada and was published in 2014. Indeed, EPIC stands for expanding paramedicine in the community. This study took the form of a randomized controlled trials so that the study was focused on the right things but was randomized in such a way so as to keep the results as scientific and as applicable as possible (Drennan et al., 2014).

The diseases and conditions that were part of the EPIC study are echoed in the community paramedicine paradigms around the world and the studies that are done for the same. They include diabetes mellitus, heart failure, chronic obstructive pulmonary disease (COPD) and so forth. All of those quite nasty diseases and disorders are on the rise and it is the people that are served by community paramedicine professionals, EMS workers and otherwise, that are most at risk. As partially noted above and already, the entire point of community paramedicine programs is to improve the outcomes for the people that are most at risk and reduce the needs they have for acute and emergency care. Also as noted before, it is this acute and emergency care that is most expensive to both the providers themselves as well as the patients and other people that end up having to pay for the same. A final thing that will be mentioned in this section that was mentioned before would be the fact that changes and updates to EMS programs like community paramedicine need to be based as much as possible on the legal rules and frameworks that exist as well as the evidence from prior implementations and studies. Programs and studies like EPIC serve as a test to show where things have gone, whether those methods should continue and what perhaps should be tried instead based on those same prior results. Finally, one does not have to rely solely on domestic studies of healthcare. Indeed, while Canada and Europe are very much different when it comes to healthcare and how it's implemented in the market and while the comparisons involved are often "apples and oranges" in many respects, this does not mean that American healthcare professionals and scholars cannot glean lessons and learnings from these foreign studies as some aspects thereof can indeed be implemented or at least tested in American contexts. Even if there are stark differences between the healthcare systems of the world, there are also some major similarities (Drennan et al., 2014).

One thing that is clear from the evidence and the history is that funding is a huge part of making community paramedicine efforts work. In the United States, there are three distinct levels of funding that are or could be involved when it comes to a given program or effort. Those levels are federal, state and local. Local can take on the form of city, county or township-level investment and Maryland is no different. Even if the efforts in Maryland (or other places) start at the local or state level, this does not mean that other or higher levels of funding cannot come into play and the paradigm later when it is proven that such investments are fruitful and useful. Indeed, Ontario, Canada has precisely that sort of thing going on. When it became clear that the community paramedicine programs already in place were useful and helpful, Ontario (the province) made it a point to invest about six million dollars to help with the thirty relevant community paramedicine programs that were active and productive within their province. This sort of thing could absolutely happen in the United States. If states like Maryland and the counties and localities within have such programs on a smaller scale and it is proven that they are effective, the federal government will eventually take notice and a swath of the federal budget can be used to help fill the gaps that exist within the American healthcare system yet are still unaddressed (Bergstrom, 2015).