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What do community paramedics assess? An environmental scan and content analysis of patient assessment in community paramedicine

  • Matthew S. Leyenaar (a1) (a2) (a3), Brent McLeod (a3) (a4) (a5), Sarah Penhearow (a6), Ryan Strum (a1) (a2), Madison Brydges (a7), Eric Mercier (a8), Audrey-Anne Brousseau (a9), Floyd Besserer (a9) (a10), Gina Agarwal (a11) (a5), Walter Tavares (a12) (a11) (a13) and Andrew P. Costa (a1) (a2) (a14) (a15)...

Abstract

Objectives

Patient assessment is a fundamental feature of community paramedicine, but the absence of a recognized standard for assessment practices contributes to uncertainty about what drives care planning and treatment decisions. Our objective was to summarize the content of assessment instruments and describe the state of current practice in community paramedicine home visit programs.

Methods

We performed an environmental scan of all community paramedicine programs in Ontario, Canada, and used content analysis to describe current assessment practices in home visit programs. The International Classification on Functioning, Disability, and Health (ICF) was used to categorize and compare assessments. Each item within each assessment form was classified according to the ICF taxonomy.

Results

A total of 43 of 52 paramedic services in Ontario, Canada, participated in the environmental scan with 24 being eligible for further investigation through content analysis of intake assessment forms. Among the 24 services, 16 met inclusion criteria for content analysis. Assessment forms contained between 13 and 252 assessment items (median 116.5, IQR 134.5). Most assessments included some content from each of the domains outlined in the ICF. At the subdomain level, only assessment of impairments of the functions of the cardiovascular, hematological, immunological, and respiratory systems appeared in all assessments.

Conclusion

Although community paramedicine home visit programs may differ in design and aim, all complete multi-domain assessments as part of patient intake. If community paramedicine home visit programs share similar characteristics but assess patients differently, it is difficult to expect that the resulting referrals, care planning, treatments, or interventions will be similar.

Objectifs

L’évaluation des patients est un élément fondamental de la pratique de la paramédecine communautaire, mais l'absence de norme reconnue en matière d’évaluation contribue à l'incertitude qui plane sur les facteurs pris en considération dans la planification des soins et les prises de décision relatives au traitement. L’étude visait donc à présenter un résumé du contenu des instruments d’évaluation et à décrire l’état de la pratique actuelle dans les programmes de visites à domicile en paramédecine communautaire.

Méthode

L’étude consistait en une analyse environnementale de tous les programmes de paramédecine communautaire offerts en Ontario et en une analyse de contenu visant à décrire les pratiques actuelles d’évaluation des patients appliquées dans le cadre des programmes de visites à domicile. Les chercheurs se sont référés à la Classification internationale du fonctionnement, du handicap et de la santé (CIF) pour comparer et classer les évaluations, et chacun des éléments inscrits sur chaque formulaire d’évaluation a été classé selon la taxonomie de la CIF.

Résultats

Au total, 43 services paramédicaux sur 52, en Ontario, ont participé à l'analyse environnementale, dont 24 se prêtaient à une recherche approfondie reposant sur une analyse de contenu des formulaires d’évaluation initiale. Sur les 24 services, 16 répondaient aux critères de sélection en vue d'une analyse de contenu. Le nombre d’éléments évalués variait de 13 à 252 selon les formulaires (médiane : 116,5; écart interquartile : 134,5). La plupart des questionnaires contenaient des éléments tirés de chacun des domaines inscrits dans la CIF. Au niveau des sous-domaines, seule l’évaluation des troubles de fonctionnement des systèmes cardiovasculaire, sanguin, immunitaire et respiratoire figuraient sur tous les formulaires.

Conclusion

Les programmes de visites à domicile en paramédecine communautaire peuvent certes avoir des différences de conception et de but, mais ils permettent tous une évaluation pluridimensionnelle des nouveaux patients. Si les programmes de visites à domicile en paramédecine communautaire ont des caractéristiques communes mais des formes d’évaluation différentes, il est difficile de s'attendre à des résultats comparables en ce qui concerne les consultations, les plans de soins, les traitements et les interventions.

Copyright

Corresponding author

Correspondence to: Matthew S. Leyenaar, McMaster University CRL-219, 1280 Main St. W., Hamilton, ON L8S 4K1; Email: leyenam@mcmaster.ca

References

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Supplementary materials

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What do community paramedics assess? An environmental scan and content analysis of patient assessment in community paramedicine

  • Matthew S. Leyenaar (a1) (a2) (a3), Brent McLeod (a3) (a4) (a5), Sarah Penhearow (a6), Ryan Strum (a1) (a2), Madison Brydges (a7), Eric Mercier (a8), Audrey-Anne Brousseau (a9), Floyd Besserer (a9) (a10), Gina Agarwal (a11) (a5), Walter Tavares (a12) (a11) (a13) and Andrew P. Costa (a1) (a2) (a14) (a15)...

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