• Is it cost effective to introduce paramedic practitioners for older people to the ambulance service?

    by Alan Batt. Last modified: 18/03/14

     
    Dixon S1, Mason S, Knowles E, Colwell B, Wardrope J, Snooks H, Gorringe R, Perrin J, Nicholl J. Is it cost effective to introduce paramedic practitioners for older people to the ambulance service? Results of a cluster randomised controlled trial. Emerg Med J. 2009 Jun;26(6):446-51. PMID: 19465624.

    Abstract

    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 UK pounds 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 UK pounds per QALY.

    Conclusions

    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.

    References

     
    1.

    Dixon S1, Mason S, Knowles E, Colwell B, Wardrope J, Snooks H, Gorringe R, Perrin J, Nicholl J. Is it cost effective to introduce paramedic practitioners for older people to the ambulance service? Results of a cluster randomised controlled trial. Emerg Med J. 2009 Jun;26(6):446-51. PMID: 19465624.

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    Alan Batt

    Alan Batt

    Paramedic, educator, researcher
    Alan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. He has previously worked and studied across Europe, North America and the Middle East. He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education.

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