• Is it cost effective to introduce paramedic practitioners for older people to the ambulance service? Results of a cluster randomised controlled trial

      Dixon, S.; Mason, Suzanne; Knowles, Emma; Colwell, Brigitte; Wardrope, Jim; Snooks, Helen; Gorringe, R.; Perrin, J.; Nicholl, Jon (2009-05-22)
      Background: A scheme to train paramedics to undertake a greater role in the care of older people following a call for an emergency ambulance was developed in a large city in the UK. Objectives: To assess the cost effectiveness of the paramedic practitioner (PP) scheme compared with usual emergency care. Methods: A cluster randomised controlled trial was undertaken of PP compared with usual care. Weeks were allocated to the study group at random to the PP scheme either being active (intervention) or inactive (control). Resource use data were collected from routine sources, and from patient-completed questionnaires for events up to 28 days. EQ-5D data were also collected at 28 days. Results: Whereas the intervention group received more PP contact time, it reduced the proportion of emergency department (ED) attendances (53.3% vs 84.0%) and time in the ED (126.6 vs 211.3 minutes). There was also some evidence of increased use of health services in the days following the incident for patients in the intervention group. Overall, total costs in the intervention group were £140 lower when routine data were considered (p = 0.63). When the costs and QALY were considered simultaneously, PP had a greater than 95% chance of being cost effective at £20 000 per QALY. Conclusion: Several changes in resource use are associated with the use of PP. Given these economic results in tandem with the clinical, operational and patient-related benefits, the wider implementation and evaluation of similar schemes should be considered. https://emj.bmj.com/content/26/6/446. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emj.2008.061424
    • Is there scope for an observational pain scoring tool in paramedic practice?

      Harvey, Christopher (2014-02)
      Abstract published with permission. In the pre-hospital environment, attending an older person can pose many challenges, including a lack of a detailed history, polypharmacy and co-morbidities, as well as a lack of out-of-hours support to name but a few. These challenges are enhanced further when the patient is cognitively impaired by syndromes such as dementia. There appears to be very little research available into how the pain of older people with dementia is assessed and managed by paramedics. This article highlights a literature review that was carried out to explore the evidence base and possible implementation of the Abbey Pain Scale, with the view of conducting a study in the near future. Particular focus is made on the education and training required to implement the tool, other environments where it has been adopted, as well as benefits and limitations.
    • A Pilot Study of the Impact of NHS Patient Transportation on Older People with Dementia

      Roberts, Nicola; Curran, Stephen; Minogue, Virginia; Shewan, Jane; Spencer, Rebecca; Wattis, John (2010-06-14)