Limited data to support improved outcomes after community paramedicine intervention: A systematic review

Background: Community paramedicine (CP) leverages trained emergency medical services personnel outside of emergency response as an innovative model of health care delivery. Often used to bridge local gaps in healthcare delivery, the CP model has existed for decades. Recently, the number of programs has increased. However, the level of robust data to support this model is less well known. Objective: To describe the evidence supporting community paramedicine practice. Data sources: OVID, PubMed, SCOPUS, EMBASE, Google Scholar-WorldCat, OpenGrey. Study appraisal and synthesis methods: Three people independently reviewed each abstract and subsequently eligible manuscript using prespecified criteria. A narrative synthesis of the findings from the included studies, structured around the type of intervention, target population characteristics, type of outcome and intervention content is presented. Results: A total of 1098 titles/abstracts were identified. Of these 21 manuscripts met our eligibility criteria for full manuscript review. After full manuscript review, only 6 ultimately met all eligibility criteria. Given the heterogeneity of study design and outcomes, we report a description of each study. Overall, this review suggests CP is effective at reducing acute care utilization. Limitations: The small number of available manuscripts, combined with the lack of robust study designs (only one randomized controlled trial) limits our findings. Conclusions: Initial studies suggest benefits of the CP model; however, notable evidence gaps remain. (C) 2019 Elsevier Inc. All rights reserved.