A Qualitative RE-AIM Evaluation of an Embedded Community Paramedicine Program in an Ontario Family Health Team

Title: A qualitative RE-AIM evaluation of an embedded community paramedicine program in an Ontario Family Health Team

Introduction: In 2014, a rural Family Health Team (FHT) in Ontario, Canada embedded a community paramedicine program into their primary care practice to improve care for their complex patients. Community paramedics are health care professionals who extend their role beyond emergency services to provide primary care in home and community settings.   

Objective: The study aims to evaluate the utility of having community paramedics embedded in a rural FHT.   

Methods: In this evaluation, we conducted 12 semi-structured interviews with the community paramedicine team (n=4) and other staff from the FHT (n=8), including physicians, nurse practitioners, allied health professionals, and the program director. We conducted a deductive thematic analysis using the RE-AIM framework. This allowed us to examine the strengths and challenges of incorporating community paramedics in this primary care model in a rural setting.    
 
Results: Reach: The community paramedicine program was primarily used by physicians to target older patients with multiple chronic conditions, frequent health care use, and limited social support. Effectiveness: In-home visits by community paramedics yielded a detailed picture of patients' health-related behaviours, such as medication adherence and dietary habits, improving understanding of patient needs and informing care strategies. Adoption: Community paramedics valued the opportunity to build long-lasting patient relationships. Implementation: The FHT’s rural location was a significant external barrier limiting the paramedic program’s ability to serve a larger patient caseload. Maintenance: The community paramedicine program aligned with the FHT’s mission to improve access to care for vulnerable patients.  

Conclusion: Our findings highlighted community paramedics' role in supporting high-needs older patients with multiple comorbidities, particularly in rural settings where access to healthcare is often limited. To support the broader adoption of this model, we developed a “how to” blueprint for embedding community paramedics in primary care settings to address the care needs of high-risk older adults that was distributed to all FHTs across Ontario.