Gina Agarwal|Ricardo Angeles|Melissa Pirrie|Brent McLeod|Francine Marzanek|Jenna Parascandalo|Lehana Thabane
Reducing 9-1-1 Emergency Medical Service Calls By Implementing A Community Paramedicine Program For Vulnerable Older Adults In Public Housing In Canada: A Multi-Site Cluster Randomized Controlled Trial
objective older adults account 3848 emergency medical service ems calls chronic diseases low income lower quality life mobile integrated health community paramedicine may help address health inequalities reduce ems calls study examines effectiveness community paramedicine clinic cpclinic program decreasing ems calls improving health outcomes lowincome older adults methods openlabel pragmatic clusterrandomized controlled trial conducted within subsidized public housing buildings older adults 5 paramedic services across ontario canada total 30 apartment buildings eligible 50 units 60 units occupied older adults unique postal code available match pairing paired buildings randomly allocated intervention cpclinic one year control usual care via computergenerated randomization cpclinic intervention communitybased paramedicled health promotion disease prevention program held weekly building common rooms cpclinic includes risk assessment validated tools decision support health promotion referrals resources reports back family doctors residents could participate older adults 55 years older included analyses primary outcome buildinglevel ems calls paramedic service databases secondary outcomes individuallevel changes chronic disease risk factors qualityadjustedlifeyears qalys data analyzed using generalized estimating equations account clustering sites results intentiontotreat analysis showed significant difference ems calls mean difference 037100 apartment unitsmonth 95ci 098 024 sensitivity analysis excluding data 2 building pairs eligibility changes intervention initiation revealed significant difference ems calls favor intervention buildings mean difference 090100 apartment unitsmonth 95ci 154 026 individual level significant qaly increase mean difference 006 95ci 002 010 blood pressure decrease systolic mean change 365 mmhg 95ci 237 494 diastolic mean change 203 mmhg 95ci 100 306 conclusions cpclinic showed significant decrease ems calls decrease bp improvement qalys among older adults subsidizing public housing suggesting simple program replicated communities public housing trial registration clinicaltrialsgov registration nct02152891