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Paramedic Assessment of Older Adults After Falls, Including Community Care Referral Pathway: Cluster Randomized Trial

Published on Oct 1, 2017in Annals of Emergency Medicine5.209
· DOI :10.1016/j.annemergmed.2017.01.006
Helen Snooks28
Estimated H-index: 28
(Swansea University),
Rebecca Anthony7
Estimated H-index: 7
(Swansea University)
+ 18 AuthorsIan Russell43
Estimated H-index: 43
(Swansea University)
Abstract
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.
  • References (26)
  • Citations (8)
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References26
Newest
#1Miranta Antoniou (University of Liverpool)H-Index: 2
#2Andrea Jorgensen (University of Liverpool)H-Index: 27
Last. Ruwanthi Kolamunnage-Dona (University of Liverpool)H-Index: 17
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Stratified or personalized medicine is a rapidly growing area of research and has attracted much attention in recent years not only in the field of oncology but also in other diseases. The aim of stratified medicine is to tailor the treatment given to a patient according to one or more personal characteristics. These characteristics can be demographic such as age or gender, or biological such as a genetic or other biomarker. Prior to utilising a patient's biomarker information in clinical practi...
Source
#1Marina Koniotou (Swansea University)H-Index: 4
#2Bridie Evans (Swansea University)H-Index: 7
Last. Helen Snooks (Swansea University)H-Index: 28
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Background Health services research is expected to involve service users as active partners in the research process, but few examples report how this has been achieved in practice in trials. We implemented a model to involve service users in a multi-centre randomised controlled trial in pre-hospital emergency care. We used the generic Standard Operating Procedure (SOP) from our Clinical Trials Unit (CTU) as the basis for creating a model to fit the context and population of the SAFER 2 trial.
6 CitationsSource
#1A. Stefanie Mikolaizak (UNSW: University of New South Wales)H-Index: 12
#2Paul M Simpson (UNSW: University of New South Wales)H-Index: 13
Last. Jacqueline C.T. Close (UNSW: University of New South Wales)H-Index: 33
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Aim To review the evidence regarding non-transported older people who have fallen in relation to non-transportation rates, outcomes and impact of alternate care pathways. Method Electronic databases and reference lists of included studies (up to December 2011) were systematically searched. Studies were eligible if they included data on non-transportation rates, information on outcomes or alternate care pathways for older people who have fallen. Results Twelve studies were included. Non-transport...
24 CitationsSource
#1Gareth DarnellH-Index: 1
#2Suzanne MasonH-Index: 31
Last. Helen Snooks (Swansea University)H-Index: 28
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Objective To provide a detailed description of the current UK ambulance service provision for older people who fall. Method National survey of UK ambulance services. Results 11/13 Ambulance services (84.6%) participated in this national survey. Conclusion This survey has highlighted the need for robust evidence to inform policy, service and practice development to improve the care of this vulnerable population.
9 CitationsSource
#1Tracey Sach (UEA: University of East Anglia)H-Index: 30
#2Pip Logan (University of Nottingham)H-Index: 17
Last. Anthony J Avery (University of Nottingham)H-Index: 47
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Objective: we estimated the cost-effectiveness of a community falls prevention service compared with usual care from a National Health Service and personal social services perspective over the 12 month trial period. Design: a cost-effectiveness and cost utility analysis alongside a randomised controlled trial Setting: community. Participants: people over 60 years of age living at home or in residential care who had fallen and called an emergency ambulance but were not taken to hospital. Interven...
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#1B FletcherH-Index: 11
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Background Poor recruitment to randomised controlled trials (RCTs) is a widespread problem. Provision of interventions aimed at supporting or incentivising clinicians may improve recruitment to RCTs. Objectives To quantify the effects of strategies aimed at improving the recruitment activity of clinicians in RCTs, complemented with a synthesis of qualitative evidence related to clinicians9 attitudes towards recruiting to RCTs. Data sources A systematic review of English and non-English articles ...
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#1Pip Logan (University of Nottingham)H-Index: 17
#2Carol Coupland (University of Nottingham)H-Index: 53
Last. Anthony J Avery (University of Nottingham)H-Index: 47
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Objective To evaluate whether a service to prevent falls in the community would help reduce the rate of falls in older people who call an emergency ambulance when they fall but are not taken to hospital. Design Randomised controlled trial. Setting Community covered by four primary care trusts, England. Participants 204 adults aged more than 60 living at home or in residential care who had fallen and called an emergency ambulance but were not taken to hospital. Interventions Referral to community...
83 CitationsSource
#1Ronan A Lyons (Swansea University)H-Index: 52
#2Kerina H. Jones (Swansea University)H-Index: 16
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Background Vast amounts of data are collected about patients and service users in the course of health and social care service delivery. Electronic data systems for patient records have the potential to revolutionise service delivery and research. But in order to achieve this, it is essential that the ability to link the data at the individual record level be retained whilst adhering to the principles of information governance. The SAIL (Secure Anonymised Information Linkage) databank has been e...
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#1Simon Gates (Warw.: University of Warwick)H-Index: 41
#2Joanne D Fisher (Warw.: University of Warwick)H-Index: 11
Last. Sarah E Lamb (Warw.: University of Warwick)H-Index: 49
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Objective To evaluate the effectiveness of multifactorial assessment and intervention programmes to prevent falls and injuries among older adults recruited to trials in primary care, community, or emergency care settings. Design Systematic review of randomised and quasi-randomised controlled trials, and meta-analysis. Data sources Six electronic databases (Medline, Embase, CENTRAL, CINAHL, PsycINFO, Social Science Citation Index) to 22 March 2007, reference lists of included studies, and previou...
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#1Helen SnooksH-Index: 28
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