Expanding Paramedicine in the Community (EPIC): Study protocol for a randomized controlled trial

Ian R. Drennan, Katie N. Dainty, Paul Hoogeveen, Clare L. Atzema, Norm Barrette, Gillian Hawker, Jeffrey S Hoch, Wanrudee Isaranuwatchai, Jane Philpott, Chris Spearen, Walter Tavares, Linda Turner, Melissa Farrell, Tom Filosa, Jennifer Kane, Alex Kiss, Laurie J. Morrison

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


The incidence of chronic diseases, including diabetes mellitus (DM), heart failure (HF) and chronic obstructive pulmonary disease (COPD) is on the rise. The existing health care system must evolve to meet the growing needs of patients with these chronic diseases and reduce the strain on both acute care and hospital-based health care resources. Paramedics are an allied health care resource consisting of highly-trained practitioners who are comfortable working independently and in collaboration with other resources in the out-of-hospital setting. Expanding the paramedic's scope of practice to include community-based care may decrease the utilization of acute care and hospital-based health care resources by patients with chronic disease. Methods/Design: This will be a pragmatic, randomized controlled trial comparing a community paramedic intervention to standard of care for patients with one of three chronic diseases. The objective of the trial is to determine whether community paramedics conducting regular home visits, including health assessments and evidence-based treatments, in partnership with primary care physicians and other community based resources, will decrease the rate of hospitalization and emergency department use for patients with DM, HF and COPD. The primary outcome measure will be the rate of hospitalization at one year. Secondary outcomes will include measures of health system utilization, overall health status, and cost-effectiveness of the intervention over the same time period. Outcome measures will be assessed using both Poisson regression and negative binomial regression analyses to assess the primary outcome. Discussion: The results of this study will be used to inform decisions around the implementation of community paramedic programs. If successful in preventing hospitalizations, it has the ability to be scaled up to other regions, both nationally and internationally. The methods described in this paper will serve as a basis for future work related to this study.

Original languageEnglish (US)
Article number473
Issue number1
StatePublished - Dec 2 2014
Externally publishedYes


  • Allied health personnel
  • Community health services
  • Primary health care
  • Randomized controlled trial

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Pharmacology (medical)


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