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A Culture in Transition: Paramedic Experiences with Community Referral Programs

  • Madison Brydges (a1), Chris Spearen (a2), Arija Birze (a3) and Walter Tavares (a1) (a4) (a5)

Abstract

Objectives

As an aging population continues to place strain on the health care system, many older adults are living with unmet social and medical needs. In response, Emergency Medical Services (EMS) have initiated programs that encourage paramedics to refer patients in need to community based support services. This qualitative study explores frontline paramedic experiences with referral programs to identify opportunities and challenges in their practice.

Methods

This study used an intepretivist qualitative study design involving interviews of frontline paramedics employed in a region where referral programs were in place. Interviews were semi-structured and one-on-one. Data were transcribed verbatim and analyzed using inductive open coding throughout, then grouped to identify themes. Data collection and analysis were conducted simultaneously and flexibly until saturation.

Results

Twenty-three interviews were conducted representing 6 regions. When participating with referral programs the data revealed that frontline paramedics appear to experience (a) role confusion, (b) an inadequate knowledge base, (c) inadequate feedback, (d) undefined accountability, and (e) strong patient advocacy.

Conclusions

In a strained health care system, EMS and paramedics have an opportunity to better serve patients by initiating referrals for patients they encounter with unmet social and medical needs. However, referral programs face a number of challenges that, if left poorly addressed, may threaten the success of such programs.

Objectif

Comme le poids du vieillissement de la population ne cesse d’exercer des pressions sur le système de soins de santé, bon nombre de personnes âgées ont des besoins médicaux et sociaux non satisfaits. Devant cette situation, des services médicaux d’urgence (SMU) ont mis sur pied des programmes qui incitent les ambulanciers paramédicaux à diriger les patients dans le besoin vers des services communautaires de soutien. Il s’agit d’une étude qualitative, qui visait à examiner l’expérience des programmes d’aiguillage des patients, vécue par les ambulanciers paramédicaux de première ligne, afin d’en cerner les possibilités et les difficultés d’application dans la pratique.

Méthode

Les auteurs ont adopté un plan d’étude qualitatif, réalisé selon une approche « interprétativiste », qui consistait en des entrevues, semi-structurées et individuelles, avec des ambulanciers paramédicaux de première ligne, travaillant dans des régions où étaient appliqués les programmes d’aiguillage des patients. Les données ont d’abord été transcrites textuellement; puis analysées dans leur ensemble à l’aide d’un codage ouvert, inductif; et finalement groupées pour permettre aux chercheurs d’en dégager les grands thèmes. La collecte de données et l’analyse ont été réalisées en même temps et avec souplesse jusqu’à saturation.

Résultats

il y a eu 23 entrevues, concernant 6 régions. D’après les données recueillies sur les ambulanciers paramédicaux de première ligne, qui participaient aux programmes d’aiguillage des patients, il semblait y avoir : a) une confusion de rôle; b) une base insuffisante de connaissances; c) un manque de rétroaction; d) une obligation de répondre de ses actes non définie; (e) une forte empathie pour les patients.

Conclusions

Dans un système de soins de santé soumis à de fortes pressions, les SMU et les ambulanciers paramédicaux ont la possibilité de mieux rendre service aux patients qu’ils rencontrent en dirigeant ceux qui ont des besoins médicaux et sociaux non satisfaits vers les ressources appropriées. Toutefois, ces programmes connaissent un certain nombre de problèmes qui, s’ils sont négligés, risquent de nuire à leur réussite.

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Copyright

Corresponding author

Correspondence to: Madison Brydges, Kenneth Taylor Hall, McMaster University, Room 226, 1280 Main Street W., Hamilton, ON, L8S 4M4; Email:madison.brydges@gmail.com

References

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