Integrating paramedics into primary care to optimize patient time in the community at end of life

Health Research BC is providing match funds for this research project, which is funded by CIHR’s Strategy for Patient Oriented Research (SPOR) Primary and Integrated Health Care Innovations (PIHCI) Network – Comparative Program and Policy Analysis Grant.

Many Canadians wish to spend their dying days at home. Despite this, 70 percent of deaths occur in hospital, the majority after a visit to the emergency department (ED). Paramedics, also known as emergency medical services (EMS), facilitate more than half of ED visits for patients receiving palliative care for a chronic condition.

One of the goals of British Columbia’s provincial palliative care strategies is to help enable people to stay at home as long as possible during their end of life. Currently, BC does not have a palliative care program within its Emergency Health Services (EHS).

Drs. Sabrina Wong and Jennifer Kryworuchko, faculty in the School of Nursing and Centre for Health Services and Policy Research at the University of British Columbia (UBC) are leading a team of researchers investigating innovative ways to deliver integrated emergency health services that support palliative care. The BC team collaborate with counterpart research team members in Nova Scotia who are examining the impact of the Nova Scotia EHS Special Patient Program on provincially funded health services and the ability to enable palliative patients to stay at home. Researchers will compare administrative health data from the two provinces on patients who received EHS paramedic services and died non-suddenly from chronic disease.

Since 2015, paramedics in Nova Scotia have received specialized clinical training on pain and symptom management and other care and support services for palliative patients as part of the Paramedics Providing Palliative Care at Home Project (PPPCHP). The PPPCHP is intended to enhance existing palliative care resources and the end-of-life experience for patients and their families/caregivers by bridging palliative care until their usual care team can take over. Researchers will identify the core elements of the PPPCHP essential for the program to be modified for rollout in BC.

In addition to improving end-of-life care and strengthening community-based care, the adoption of the Nova Scotia model in BC and other jurisdictions has the potential to reduce transport to the ED and avoid or reduce unwanted medical treatments, interventions and hospitalizations, contributing to reduced health care system costs.