Authors: John Taplin, ACP MSc; Ian Blanchard, ACP PhD; Cheryl Barnabe, MD MSc; Christopher Doig MD MSc; Lindsay Crowshoe MD; Fiona Clement, PhD
Introduction: The City Centre Team (CCT) is a mobile integrated health care program consisting of advanced care paramedics who deliver community paramedic care as part of an interdisciplinary team in Calgary. The CCT is designed to address the unmet health needs of people experiencing homelessness who are underserved in primary care.
Objective: To compare the rates, characteristics, and costs of health service utilization of patients interacting with the CCT before and after their index visit.
Methods: The characteristics of health services, including EMS events, physician claims, and pharmaceutical dispensations were compared in the year prior to and in the year following the initial CCT visit from April 2016 to December 2018. Administrative databases were linked, and utilization rates and costs were analyzed between periods using incident rate and cost ratios in this pre-post retrospective cohort study.
Results: There was a total of 4760 CCT visits for 1360 unique patients during the study period that were included in the analysis. Following the initial CCT visit there were either no significant changes or an increase in the utilization and costs of acute health services. Likewise, there was also an observed increase in rates of primary care physician claims and costs. Pharmaceutical dispensations from community pharmacies increased, while their associated costs were not significantly different. Patients who had no pharmaceutical dispensations and those without physician claims in the pre-period were significantly less likely to have no dispensations and claims in the post-period. EMS events and associated costs were observed to increase between periods with presenting conditions primarily related to substance use and mental health disorders in both periods.
Conclusions: In the year following the initial CCT visit there were small but significant increases in the connectedness to care for people experiencing homelessness. This data suggests that the continued development and implementation of paramedics as part of an interdisciplinary care team are able to increase access to care for a traditionally underserved population with complex health needs. Research that identifies specific conditions which may benefit from community paramedic care and methods to reduce barriers is necessary to further improve access.