Community paramedicine in dementia care

Area of Science:

• Gerontology
• Emergency Medicine
• Health Services Research

Background:

• Growing number of community-dwelling dementia patients require novel hospital diversion strategies.
• Community paramedicine (CP) deploys paramedics for in-home consultation and care coordination.
• Optimal CP utilization for dementia patients remains unevaluated.

Purpose of the Study:

• Compare CP utilization and outcomes for homebound patients with and without dementia.
• Assess the effectiveness of CP in managing dementia patients within primary care settings.
• Identify differences in emergency department (ED) transport rates for dementia patients using CP.

Main Methods:

• Retrospective cohort study of 251 homebound patients using physician-led CP services (March 2017-May 2022).
• Analysis of electronic health record data including demographics, clinical characteristics, and CP encounter details.
• Chart review to determine dementia status and CP outcomes (ED transport, over-transport, under-transport), with logistic regression for adjusted analysis.

Main Results:

• 53% of CP patients had dementia; common complaints included dyspnea and altered mental status.
• No significant difference in overall ED transport rates between dementia and non-dementia groups (25.4% vs. 22.8%).
• Dementia diagnosis was associated with significantly lower over-transport rates (OR=0.21, p=0.03) and comparable under-transport rates (OR=0.70, p=0.47).

Conclusions:

• Community paramedicine effectively manages homebound patients with dementia within home-based primary care.
• CP demonstrates potential for reducing unnecessary emergency department escalations in dementia patients.
• Further research should explore cost-effectiveness and broader implementation of CP in dementia care.