Evaluating a Paramedic-Led Fall-Referral Program in Nova Scotia: a Mixed-Methods Study

Area of Science:

• Gerontology
• Public Health
• Emergency Medical Services

Background:

• Falls in older adults represent a significant global health challenge, contributing to high morbidity, mortality, and healthcare expenses.
• Paramedics are uniquely positioned to manage post-fall situations and potentially intervene in fall prevention.
• Understanding referral patterns and their effectiveness is crucial for optimizing care for elderly fallers.

Purpose of the Study:

• To quantify the frequency of paramedic referrals to fall prevention programs.
• To identify factors influencing paramedics' referral decisions.
• To compare fall-related outcomes between older adults who received a referral and those who did not.

Main Methods:

• A mixed-methods approach was employed, evaluating a paramedic fall-referral program in Nova Scotia for older adults with non-transport dispositions.
• Patient data and outcomes were analyzed using a matched cohort design (1:2 ratio).
• Paramedic perspectives on the referral program were explored using The Theory of Planned Behavior.

Main Results:

• Between 2014 and 2019, 289 referrals were made.
• A matched cohort analysis revealed no significant difference in the mean number of fall-related 911 calls within 12 months between referred and non-referred groups (0.31 vs. 0.30 calls).
• Paramedics cited patient reluctance, insufficient education, lack of feedback, and program systematization issues as major referral barriers.

Conclusions:

• The paramedic fall-prevention referral program in Nova Scotia demonstrated low referral rates and did not significantly reduce recurrent fall-related emergency calls.
• Addressing barriers such as patient engagement, paramedic education, and feedback mechanisms is essential for improving the effectiveness of such programs.
• Paramedics can play an enhanced role in preventing age-related health issues like falls through improved referral systems.