A qualitative RE-AIM evaluation of an embedded community paramedicine program in an Ontario Family Health Team.

Background: In 2014, a rural Family Health Team (FHT) in Ontario, Canada embedded a community paramedicine program into their primary care practice to improve care for their complex patients. Community paramedics are health care professionals who extend their role beyond emergency services to provide primary care in home and community settings. The study aims to evaluate the utility of having community paramedics embedded in a rural FHT.

Methods: In this qualitative study, we conducted 12 semi-structured interviews with the community paramedicine team (n=4) and other staff from the FHT (n=8), including physicians, nurse practitioners, allied health professionals (AHPs), and the program director. We conducted a deductive and thematic analysis using the RE-AIM framework. This allowed us to examine the strengths and challenges of incorporating community paramedics in a primary care model for providers and coordinating patient care in a rural setting.

Results: Reach: The community paramedicine program is primarily used by physicians to target older patients with multiple chronic conditions, frequent health care use, and limited social support.

Effectiveness: In-home visits by community paramedics yield a detailed picture of patients' health-related behaviours, such as medication adherence and dietary habits, improving the FHT's understanding of patient needs and informing care strategies. Adoption: Community paramedics value the opportunity to build long-lasting patient relationships.

Implementation: The FHT's rural location is a significant external barrier limiting the paramedic program's ability to serve a larger patient caseload. Maintenance: The program aligns with the FHT's mission to improve access to care for vulnerable patients.

Conclusions: Our findings highlight community paramedics' role in supporting high-needs patients, particularly in rural settings. The average age of patients in the program is 78, and they often have multiple comorbidities, including prevalent dementia. Such health conditions necessitate home visits to gather accurate health information often masked in clinic settings. Embedding community paramedics in a primary care model improves access to care and provides more support for patients with complex needs. Using these findings, we developed a "how to" blueprint for embedding community paramedics in primary care settings to address the care needs of high-risk older adults.

Clinical trial number: Not applicable.