Effect of the CP@clinic program (Community Paramedicine at Clinic program) on health care utilization from administrative data during and after the intervention: a cluster-randomized controlled trial
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Gina Agarwal1,2, Melissa Pirrie1, Manasvi Sai Vanama1
1Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
Introduction:
The study objective was to compare the effects of the Community Paramedicine at Clinic (CP@clinic) program versus usual care on building-level health service utilization during a 12-month trial period and 12 months post-trial.
Methods:
This study employed a longitudinal, repeated cross-sectional design within a cluster-randomized controlled trial (RCT). It involved 30 apartment buildings across five Ontario communities, housing low-income older adults. Buildings were paired and randomized to receive either the CP@clinic intervention or continuing with usual care. Data was derived from ICES-maintained administrative health databases, linked using unique identifiers. The sample included all residents aged 55 + in the study postal codes from the Ontario Health Insurance Plan (OHIP) Registered Persons Database (RPDB), excluding those aged 120+, ineligible for OHIP, and those with no health care encounters within 7 years. The primary health care utilization outcome was emergency department visits by ambulance and other outcomes included hospital admissions and primary care visits.
Results:
CP@clinic buildings showed significantly lower hospital admission rates during both the 12-month RCT period (adjusted incidence rate ratio [aIRR]: 0.75 [0.61,0.91]) and the 12-month post-RCT period [aIRR: 0.82 (0.70,0.96)] compared to usual care buildings. Primary care visits were lower in CP@clinic buildings during the RCT (aIRR: 0.93 [0.88,0.99]) but higher in the post-RCT period (aIRR: 1.05 [1.00,1.10]). No significant differences were found in emergency department visits or the number of days admitted between groups in either period.
Discussion:
CP@clinic was linked to a sustained reduction in hospital admissions and an increase in primary care visits beyond the RCT time period, reflecting a shift from reactive to preventive care among older adults residing in social housing. The lasting impact beyond the RCT period suggests that the CP@clinic Program can improve health system efficiency, primary care access, and reduce health inequities in vulnerable populations.
Trial Registration:
ClinicalTrials.gov, Identifier: NCT02152891.
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