Patient experiences in rural Northern Ontario: small hospital utilization and perspectives on community paramedicine

Abstract

This thesis adhered to an integrated article format with two distinct studies focusing on the analysis of patient medical records from a rural hospital in north east Ontario (Study 1) and a cross-sectional observational investigation of patient perspectives on community paramedicine (CP) (Study 2). The aim of Study 1 was to help hospital administrators identify patients at high risk of frequent hospital resource utilization (emergency department (ED) visit or admissions) so that if appropriate, they may be redirected to alternative services available in the community. Therefore, the two main research questions for this study were: (1) Which types of patients are more prone to having repeat ED visits and hospital admissions; and (2) What types of services could better serve or help improve the health of these patients? Study 2 aimed to evaluate patient and caregiver perspectives related to their involvement in three CP programs in rural communities across Northern Ontario. There were two research questions guiding the evaluation of patient perspectives in this study: (1) How effective is CP at supporting patient-centered care; and (2) How do perceptions differ between home visit (HV) and wellness clinic (WC) patients? In Study 1, twenty-six patients met the criteria for repeat ED visits (65% female; mean age 52 years) and accounted for a total of 623 ED visits. Seventeen patients met the criteria for repeat admissions (41.2% female; mean age 73 years) and accounted for 69 repeat hospital admissions. The most common reason cited for repeat ED visits was dressing changes and the most common reason cited for repeat admissions was chronic obstructive pulmonary disease. For Study 2, 91.7% (n=55) of patients reported being satisfied with the CP services they received and 98.3% (n=59) of the patients indicated that they would recommend CP to others. Patient perspectives of CP suggest that the service model is consistent with a patient-centered framework that includes interpersonal, psychosocial, clinical, and structural dimensions. The patients also valued CP for the ease of access and the reassurance provided by the paramedics monitoring their health concerns. Our studies found that an older population with increased health needs appear acceptable towards receiving alternative health care services outside of the hospital. Based on the perspectives of patients currently enrolled in CP programs across Northern Ontario, the HV and WC services of CP appeared to be considered as an acceptable program that can provide patient-centered care in rural and northern communities. Collectively, these two studies provide important data related to the patient experience in a rural and northern health care system context. These are encouraging signs that alternative health care services, like the CP programs, can address non-urgent issues for residents of northern and rural communities in Ontario.