Helen A Snooks1, Rebecca Anthony2, Robin Chatters3, Jeremy Dale4, Rachael T Fothergill5, Sarah Gaze2, Mary Halter6, Ioan Humphreys7, Marina Koniotou2, Phillipa Logan8, Ronan A Lyons9, Suzanne Mason3, Jon Nicholl3, Julie Peconi2, Ceri Phillips7, Alison Porter2, Aloysius Niroshan Siriwardena10, Mushtaq Wani11, Alan Watkins2, Lynsey Wilson2, Ian T Russell2. 1. Swansea University Medical School, Swansea, Wales, United Kingdom. Electronic address: h.a.snooks@swansea.ac.uk. 2. Swansea University Medical School, Swansea, Wales, United Kingdom. 3. School of Health and Related Research, University of Sheffield, Sheffield, England. 4. Warwick Medical School, University of Warwick, Coventry, England. 5. Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, England. 6. Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, England. 7. Swansea University, Swansea Centre for Health Economics, Swansea, Wales. 8. Community Health Sciences, University of Nottingham, Nottingham, England. 9. Swansea University Medical School, Swansea, Wales, United Kingdom; Farr Institute, Swansea University, Swansea, Wales. 10. School of Health and Social Care, University of Lincoln, Lincoln, England. 11. Department of Geriatric and Stroke Medicine, Morriston Hospital, Swansea, Wales.
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.
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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