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Tuesday, August 25, 2015

New breed of paramedics treats patients before emergencies occur - LA Times

When  does a paramedic become a independent health care provider. The line between physicians, nurses, physicians assistance is  becoming blurred as the future of health care evolves.

Paramedic Jacob Modglin parks on a palm-lined street in Oxnard and jumps out of his ambulance. 
He is prepared for any kind of emergency.
But his patient is standing in the driveway of a one-story house, holding a thermos, and smiling. It's time for his 8 p.m. appointment.
Modglin is part of a new cadre of "community paramedics" working in a dozen pilot programs across California. Their jobs are to treat patients before they get sick enough to need emergency care.
Many insurance companies and healthcare providers are seeking to curb spending by focusing on the small number of patients who drive the majority of costs. These so-called super-utilizers often have chronic conditions or other social problems that keep sending them to hospital emergency rooms and racking up big bills.
A patient who visits an emergency room unnecessarily or is repeatedly admitted to a hospital, for instance, could be suffering from a chronic medical condition, or may not be able to afford medicine, or may be too frail to go pick up fresh food — or all of the above.
That makes it difficult to know how to assist these patients. But California healthcare leaders hope these specially trained community paramedics can help.
"There's a missing link in the chain here and we don't know what that is, but we're trying to find out," said Dr. Steven Rottman, medical director of the UCLA Center for Prehospital Care, which trained the community paramedics.
Willl this become the next standard of care ?  

In Ventura County, Modglin administers tuberculosis medicine to infected patients. Health officials there are worried about the illness — especially some cases that appear drug-resistant — and believe paramedics are in the best position to help stop its spread by providing patients with pills each day at their homes.

This may be useful during times when paramedics are idle, however sudden emergency 911 calls may divert these first responders to a timely  call.  Using paramedic-firemen seems to be a shortcut that will fail.

In addition to that who reimburses for the preventive medicine care?  Is this a public service ordinarily paid for by the taxpayer. Does the insurance company save money by  cost shifting to the tax payers?

Chatting under a fruit tree in the house's frontyard, they also talk about the patient's diabetes and the medicine that controls his high blood pressure. Modglin takes a look at the man's knee, because he slipped and fell earlier in the day.
"Not only do I administer his TB medicine, but I'm here to make sure his overall health is good," Modglin said.
Ventura County runs the tuberculosis program and another that sends paramedics to the homes of hospice patients.
Los Angeles County has two initiatives as well, gearing up next month. In one, community paramedics in Glendale will visit patients with congestive heart failure within three days of their discharge from the hospital. They will try to make sure those patients — who typically have high readmission rates — are following their doctors' recommendations and living in an environment that's conducive to recovery.
With the advent of telemedicine it may allow physician supervision of first responders, much like first responders who communicate with an emergency  room in  transit as they treat a critically ill patient, such as in shock or in cardiac arrest.
As this concept spread there should be a careful evaluation. In 2017, researchers from UC San Francisco will evaluate the programs' success.
California's modern version of these emergency responders originated with a pilot program in Los Angeles County in the late 1960s as people started to take note of a high number of cardiac arrest deaths occurring outside hospitals. In 1970, California became the first state in the nation to allow paramedics to perform advanced medical life support.
But these days, Glendale paramedic Todd Tucker estimates that 10% to 20% of his calls aren't medical emergencies.
"We get called for you-name-it," said the Glendale fire captain, who's part of both Los Angeles County pilot programs. 

New breed of paramedics treats patients before emergencies occur - LA Times

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