Home care paramedicine, why not like this?

[DwayneEMTP]

Hey All,

I ran across this today,

http://www.ems1.com/...requent-flyers/

This program is several years old. Is anyone familiar with it?

Is it doing well?

Why aren't more programs like this being developed?

And "Because American medics are idiots and you could never trust them to care for patients in their homes" really isn't an answer, as it appears that this program developed a way to screen and then educated the non idiots.

Seems like a good idea, right?

[MongoMedic2]

I remember reading about a program in Main or Mass. (I don't remember which) where Paramedics would go to homes to do house calls. They would have a pretty expanded scope of practice (similiar to that of a Remote Medic). They would do antibiotic therap, minor suturing, along with a whole host of treatments right in the patients home. I have no seen much press on how it faired or if it even still exist in that area.

I do know that this is becoming a popular idea in Texas. I personally know of a company that is starting up right now that will be doing this exact thing. They will be using tele-medicine to speak with a "coordinating doctor" (for lack of better terms) along with a very expanded protocol system and armed with all kinds of cool things (monitor, I-stats, etc.). They will also be following up with patients that have visited the ER, admitted and then sent home. Kind of a follow up program. This will in the long run assist hospitals from receiving these patients after being discharged from the hospital and the hospital having to pay medicare back.

Example: granny goes in suffering an MI. She gets admitted and treated for her MI, now (according to my sources) if granny goes back to the ER for any reason that hospital has to pay medicare a said amount (sorry I don't know figures). So instead this service will basically follow up on granny ensure that she is taking medications as they are prescribed, do a physical exam, report back to the coordinating doc with findings and possible treatment plan and implement it with the coordinating doctor's approval.

That is basically what I am being told, I don't have any facts, figures, or documentation to prove/disprove this. Although I think that it is a great idea. I mean if we as Paramedics could do these sort of things and help drive down health care at the same time, I say about time

Mongomedic

[Vorenus]

I seem to remember that this programme has been adressed before, in another thread. Couldn`t find it though.

Can`t comment on US practice and developing programmes, but the whole idea is very similiar to the UK Emergency Care Practioneer/Paramedic Practioneer and Emergency Nurse Practioneers.

EDIT: Found it.

http://www.emtcity.c...__1#entry261772

Edited March 2, 2012 by Vorenus

[Kiwiology]

And "Because American medics are idiots and you could never trust them to care for patients in their homes" really isn't an answer, as it appears that this program developed a way to screen and then educated the non idiots.

But Dwayne since Rob died who is going to keep reminding you of that all important fact if nobody says it? I mean I know you know it already and it kills you a little bit inside each and every time we foreigners talk about how fucking awesome our systems are (actually our system sucks, did I tell you that? Because it really does...)

I think you need significant changes to reimbursement and education to make it work. If Medicare and insurance pays you for assessment rather than transport and your people are educated enough not to leave people at home who should not be (even we're not perfect at it) then yes, it could work quite well.

The ability to filter people out of the response grid at time of call is also a good tool like the Clinical Advice Paramedics in London who take green category calls (MPDS alpha or bravo) which would normally wait a couple of hours for a big yellow box are now given telephone advice or referred to their GP or NHS Direct. We have a similar program where very low priority calls are screened out and sent to Healthline.

All of our ambulance crews have the ability to leave people at home or refer them elsewhere e.g. GP or urgent clinic.

It is not about having a fancy bag of tricks i.e. being able to do more it's more about being able to send the patient somewhere else more appropriate than the emergency department.

Take a look at the CARE Program in New South Wales http://www.changechampions.com.au/resource/Katie-ODonnell.pdf

[DwayneEMTP]

It seems to me that if the additional education was required, that though it would be ok I guess, I don't see why a significantly expanded scope of practice would be necessary?

It's seems that for the most part assessment, excellent communication, and an ability to organize non emergent services would be more important.

I've done sutures twice, handed out skads of antibiotics, but each time only because there wasn't a physician realistically available to do it instead. In an environment that has a medical clinic on every corner I'm not sure that that would be necessary.

It seems that a few places have started, and the tests seemed promising, I'm curious as to why it's not taken off like wildfire...

[Eydawn]

What, you mean like the program that my community is just starting up?

http://www.coloradoan.com/apps/pbcs.dll/article?AID=2012202100337

Cheers...

Wendy

CO EMT-B

[mikemedic999]

In the uk we have emergency care practitioners. They can do all that!

[Vorenus]

It seems to me that if the additional education was required, that though it would be ok I guess, I don't see why a significantly expanded scope of practice would be necessary? It's seems that for the most part assessment, excellent communication, and an ability to organize non emergent services would be more important. I've done sutures twice, handed out skads of antibiotics, but each time only because there wasn't a physician realistically available to do it instead. In an environment that has a medical clinic on every corner I'm not sure that that would be necessary. It seems that a few places have started, and the tests seemed promising, I'm curious as to why it's not taken off like wildfire...

It`s really all about the education, not really about the scope, since you guys often have a significantly wide scope of practice anyways in regards to the average time spent in school to reach EMT-P. Leaving someone at home and therefore being the only medical professional having had a look on the patient takes significantly more inside knowledge than doing all the protocol-based fancy stuff and refering to a site of higher academic education. Guess that`s why it hasn`t been widely established in a system, where EMS is mostly non-HE dependant.

It seems to me that if the additional education was required, that though it would be ok I guess, I don't see why a significantly expanded scope of practice would be necessary? It's seems that for the most part assessment, excellent communication, and an ability to organize non emergent services would be more important. I've done sutures twice, handed out skads of antibiotics, but each time only because there wasn't a physician realistically available to do it instead. In an environment that has a medical clinic on every corner I'm not sure that that would be necessary. It seems that a few places have started, and the tests seemed promising, I'm curious as to why it's not taken off like wildfire...

It`s really all about the education, not really about the scope, since you guys often have a significantly wide scope of practice anyways in regards to the average time spent in school to reach EMT-P. Leaving someone at home and therefore being the only medical professional having had a look on the patient takes significantly more inside knowledge than doing all the protocol-based fancy stuff and refering to a site of higher academic education. Guess that`s why it hasn`t been widely established in a system, where EMS is mostly non-HE dependant. Edited March 2, 2012 by Vorenus

[Kiwiology]

I've ... handed out skads of antibiotics, but each time only because there wasn't a physician realistically available to do it instead. In an environment that has a medical clinic on every corner I'm not sure that that would be necessary.

I'm not trying to be a prick here mate; it's all very well to hand out some little pills to people but do you (figurative you) know the difference between Gram positive and Gram negative and what it actually means? do you know your macrolide from your cephlosporin or coccus vs vibro (no, not that thing by your ball bag or what your wife uses when she is thinking of me .. sick fuck get your mind out of the gutter) ...do you know your pathogenicity from your virulence and so on ...

[chbare]

I don't understand why we have to go from peptidoglycan to people's personal lives? Not trying to be the censorship police, but are we not representing our profession when we make comments here?