Paramedic Assessment of Older Adults After Falls, Including Community Care Referral Pathway: Cluster Randomized Trial - 23/09/17
, Rebecca Anthony a, Robin Chatters b, Jeremy Dale, PhD c, Rachael T. Fothergill, Dr (Clinical) d, Sarah Gaze a, Mary Halter, PhD e, Ioan Humphreys f, Marina Koniotou a, Phillipa Logan, PhD g, Ronan A. Lyons, PhD a, h, Suzanne Mason, PhD b, Jon Nicholl, PhD b, Julie Peconi, PhD a, Ceri Phillips, PhD f, Alison Porter, PhD a, Aloysius Niroshan Siriwardena, PhD i, Mushtaq Wani j, Alan Watkins, PhD a, Lynsey Wilson a, Ian T. Russell, PhD aAbstract |
Study objective |
We aim to determine clinical and cost-effectiveness of a paramedic protocol for the care of older people who fall.
Methods |
We undertook a cluster randomized trial in 3 UK ambulance services between March 2011 and June 2012. We included patients aged 65 years or older after an emergency call for a fall, attended by paramedics based at trial stations. Intervention paramedics could refer the patient to a community-based falls service instead of transporting the patient to the emergency department. Control paramedics provided care as usual. The primary outcome was subsequent emergency contacts or death.
Results |
One hundred five paramedics based at 14 intervention stations attended 3,073 eligible patients; 110 paramedics based at 11 control stations attended 2,841 eligible patients. We analyzed primary outcomes for 2,391 intervention and 2,264 control patients. One third of patients made further emergency contacts or died within 1 month, and two thirds within 6 months, with no difference between groups. Subsequent 999 call rates within 6 months were lower in the intervention arm (0.0125 versus 0.0172; adjusted difference –0.0045; 95% confidence interval –0.0073 to –0.0017). Intervention paramedics referred 8% of patients (204/2,420) to falls services and left fewer patients at the scene without any ongoing care. Intervention patients reported higher satisfaction with interpersonal aspects of care. There were no other differences between groups. Mean intervention cost was $23 per patient, with no difference in overall resource use between groups at 1 or 6 months.
Conclusion |
A clinical protocol for paramedics reduced emergency ambulance calls for patients attended for a fall safely and at modest cost.
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| Please see page 496 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Timothy F. Platts-Mills, MD, MSc |
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| Author contributions: HAS, JD, RTF, SG, MH, PL, RAL, SM, JN, JP, CP, ANS, MW, ITR, and conceived and designed the study. HAS is the guarantor of this article and responsible for the statistical analysis and writing process. All authors reviewed the final article. HAS takes responsibility for the paper as a whole. All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. Research funding was provided by National Institute for Health Research-Health Technology Assessment (HTA 07/01/21) and Swansea University, with additional support provided by Health and Care Research Wales. |
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| Trial registration number: Current Controlled Trials ISRCTN 60481756 |
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Vol 70 - N° 4
P. 495 - octobre 2017 Retour au numéro
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