Funder: Robert Wood Johnson Foundation
December 2018 | Case Study
After many years as a paramedic, Brian Randall often wondered: “What happened to that patient?” After rushing to the scene of an emergency, saving a patient’s life, and then transporting them to the hospital — he would never see them again. As an outgoing and curious individual, these encounters left Randall eager to know the underlying causes of the health crises he witnessed, and what interventions might truly influence a patient to change the habits influencing their health.
He began looking into community paramedicine programs focused on engaging high-risk patients. Randall completed coursework in pharmacology, disease prevention, and care standards for chronic disease management. In 2016, his employer Gold Cross Ambulance Services joined ThedaCare, a nonprofit health care system based in northeast Wisconsin, in launching a community paramedicine pilot through the Transforming Complex Care initiative.
Community paramedics visit patients in their homes and perform many duties, including medication reconciliation, monitoring vital signs, and patient education. But perhaps most important, they serve as the care team’s eyes and ears in the home. Randall checks to see if patients have their medication, are taking it regularly and as prescribed, and can report if conditions within the home (such as a lack of food or electricity) may be impacting their condition. Through ThedaCare’s electronic medical record system, Randall can keep the entire care team up-to-date, without the patient leaving their home. For a variety of reasons, many of the patients Randall sees are uncomfortable in a traditional care setting. They may simply find it easier to open up to a paramedic, who many perceive as both knowledgeable and non-judgmental. “In a crisis, we’re the cool, calm, collected ones, and whatever they’re going through — we’ve probably seen worse,” says Randall.
During home visits, Randall teaches the basic facts about chronic conditions like diabetes and also provides practical, real-world advice. “One thing that providers often tell [diabetics] is, ‘count your carbs.’ Well, I can tell you, two-thirds of my patients don’t know what a carb is,” he says. In asking patients about what foods they like to eat, Randall helps them make healthy modifications to their diet. “The key to the education is not only putting concepts into terms they can understand, but keeping it consistent.”
“Community paramedicine is for someone who craves that follow-through, and wants to make difference on a bigger scale.”
While it is clear that bringing health education out of the clinic and into a patient’s home is helpful — it is also apparent Randall has a knack for this. The young father of two is empathetic and profoundly patient. While he says he enjoyed his adrenaline-fueled days as an emergency paramedic, community paramedicine has given him a chance to do what he has always wanted: get to know patients, and treat the underlying causes of disease, not just its symptoms.
Author: Mariel Gingrich, Center for Health Care Strategies.