A Community Paramedicine Initiative for Older Adults Living in Subsidized Housing (CHAP-EMS/CP@Clinic) (CHAP-EMS)

A Community Paramedicine Initiative for Older Adults Living in Subsidized Housing (CHAP-EMS/Renamed to CP@Clinic)

Older adults living in subsidized housing report poorer health. Their age and low income make it harder for them to use community services. Many older adults have heart disease and diabetes, which lead to frequent emergency calls and hospital admissions. To decrease the costs of treating heart disease and diabetes through emergency and hospitalization, improved screening and health education is needed. Our program will take place in communal areas within housing buildings of older adults and deliver a heart disease, diabetes, and falls risk check-up with health education. This is expected to improve the health of older adults leading to fewer emergency calls and hospital visits.

Study Overview

• Status: Completed
• Conditions: Cardiovascular Diseases; Diabetes Mellitus
• Intervention / Treatment: Behavioral: CHAP-EMS/CP@clinic

• Study Type: Interventional
• Enrollment (Actual): 1200
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Guelph, Ontario, Canada, N1H 3A1
      • Guelph-Wellington Emergency Medical Services and County of Wellington Social Services Department - Housing Services
    • Hamilton, Ontario, Canada, L8P 4Y5
      • Hamilton Paramedic Services
    • Simcoe, Ontario, Canada, L0L 1X0
      • County of Simcoe
    • Sudbury, Ontario, Canada, P3A 5P3
      • City of Greater Sudbury
    • York, Ontario, Canada, L3Y 6Z1
      • York Region

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 55 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• 55 years and older
• Resides in subsidized apartment building

Exclusion Criteria:

- None

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: CHAP-EMS/CP@clinic Program Intervention; 12 month implementation of the intervention	Behavioral: CHAP-EMS/CP@clinic; Community Paramedicine program to assess cardiovascular, diabetes, and fall risk; discuss lifestyle changes and goals; and refer to appropriate resources.
No Intervention: Control; Will complete a survey at baseline and at 1 year, no program or intervention provided

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Canadian Diabetes Risk (CANRISK) Score	The CANRISK tool provides a 10-year risk of diabetes score and will be administered by the paramedic during the CHAP-EMS session.	Baseline and 1 year
Change in Blood Pressure	Since the participants are invited to attend the intervention weekly, but are not required to attend, the number of assessments and time of assessments will vary. Multilevel analysis will be conducted that accounts for this variance in repeated measures.	Baseline and after each assessment (up to one year)
Change in health perceptions, behaviours, and knowledge of resources	A face-to-face survey will be administered to determine participant health perceptions, behaviours, and knowledge.	Baseline and 1 year
Change in Health Care Utilization	Health Care Utilization will be assessed through administrative databases (e.g. hospital visits). Utilization by residents in the intervention apartment buildings will be compared to baseline and compared to the control apartment buildings.	Baseline and 1 year
Change in rate of EMS Calls	Rate EMS calls by residents in the intervention apartment buildings will be compared to baseline and compared to the control apartment buildings.	Baseline and 1 year

Collaborators and Investigators

• Sponsor: McMaster University
• Collaborators: Canadian Institutes of Health Research (CIHR); Hamilton Academic Health Sciences Organization
• Investigators: Principal Investigator: Gina Agarawal, McMaster University

Publications and helpful links

General Publications

• Agarwal G, Pirrie M, Angeles R, Marzanek F, Thabane L, O'Reilly D. Cost-effectiveness analysis of a community paramedicine programme for low-income seniors living in subsidised housing: the community paramedicine at clinic programme (CP@clinic). BMJ Open. 2020 Oct 27;10(10):e037386. doi: 10.1136/bmjopen-2020-037386.
• Agarwal G, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J, Thabane L. Reducing 9-1-1 Emergency Medical Service Calls By Implementing A Community Paramedicine Program For Vulnerable Older Adults In Public Housing In Canada: A Multi-Site Cluster Randomized Controlled Trial. Prehosp Emerg Care. 2019 Sep-Oct;23(5):718-729. doi: 10.1080/10903127.2019.1566421. Epub 2019 Feb 4.
• Agarwal G, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J, Thabane L. Evaluation of a community paramedicine health promotion and lifestyle risk assessment program for older adults who live in social housing: a cluster randomized trial. CMAJ. 2018 May 28;190(21):E638-E647. doi: 10.1503/cmaj.170740.
• Agarwal G, McDonough B, Angeles R, Pirrie M, Marzanek F, McLeod B, Dolovich L. Rationale and methods of a multicentre randomised controlled trial of the effectiveness of a Community Health Assessment Programme with Emergency Medical Services (CHAP-EMS) implemented on residents aged 55 years and older in subsidised seniors' housing buildings in Ontario, Canada. BMJ Open. 2015 Jun 11;5(6):e008110. doi: 10.1136/bmjopen-2015-008110.

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2015
• Primary Completion (Actual): November 30, 2016
• Study Completion (Actual): March 31, 2018

Study Registration Dates

• First Submitted: May 29, 2014
• First Submitted That Met QC Criteria: May 29, 2014
• First Posted (Estimate): June 2, 2014

Study Record Updates

• Last Update Posted (Actual): August 13, 2019
• Last Update Submitted That Met QC Criteria: August 12, 2019
• Last Verified: August 1, 2019

More Information

Terms related to this study

• Keywords: Elderly; Emergency Medical Services
• Additional Relevant MeSH Terms: Cardiovascular Diseases
• Other Study ID Numbers: MOP-133563

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No