title: Effectiveness of a community paramedic-led health assessment and education initiative in a seniors' residence building: the Community Health Assessment Program through Emergency Medical Services (CHAP-EMS).
abstract: Seniors living in subsidized housing have lower income, poorer health, and increased risk for cardiometabolic diseases and falls. Seniors also account for more than one third of calls to Emergency Medical Services (EMS). This study examines the effectiveness of the Community Health Assessment Program through EMS (CHAP-EMS) in reducing blood pressure, diabetes risk, and EMS calls.
  
  
  
  Paramedics on modified duty (e.g. injured) conducted weekly, one-on-one drop-in sessions in a common area of one subsidized senior's apartment building in Hamilton, Ontario. Paramedics assessed cardiovascular, diabetes, and fall risk, provided health education, referred participants to local resources, and encouraged participants to return to CHAP-EMS for follow-up. Reports were faxed to the family physician regularly. Blood pressure was collected throughout the one year intervention, while diabetes risk was assessed at baseline and after 6-12 months. EMS call volumes were collected from the Hamilton Paramedic Service for two years pre-intervention and one year during the intervention.
  
  
  
  There were 79 participants (mean age = 72.2 years) and 1,365 participant visits to CHAP-EMS. The majority were female (68%), high school educated or less (53%), had a family doctor (90%), history of hypertension (58%), high waist circumference (64%), high body mass index (61%), and high stress (53%). Many had low physical activity (42%), high fat intake (33%), low fruit/vegetable intake (30%), and were current smokers (29%). At baseline, 42% of participants had elevated blood pressure. Systolic blood pressure decreased significantly by the participant's 3rdvisit to CHAP-EMS and diastolic by the 5thvisit (p < .05). At baseline, 19% of participants had diabetes; 67% of those undiagnosed had a moderate or high risk based on the Canadian Diabetes Risk (CANRISK) assessment. 15% of participants dropped one CANRISK category (e.g. high to moderate) during the intervention. EMS call volume decreased 25% during the intervention compared to the previous two years.
  
  
  
  CHAP-EMS was associated with a reduction in emergency calls and participant blood pressure and a tendency towards lowered diabetes risk after one year of implementation within a low income subsidized housing building with a history of high EMS calls.
  
  
  
  Retrospectively registered on May 12th2016 with clinicaltrials.gov: NCT02772263.
authors.affiliation: Departments of Family Medicine, Clinical Epidemiology and Biostatistics, Quality Assurance Program Coordinator for Family Medicine Residency, Residency Program Research Coordinator, Family Medicine Residency Program, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada. agarg@mcmaster.ca.
authors.forename: G
authors.identifier: 0000-0002-5691-4675
authors.initials: G
authors.lastname: Agarwal
authors.affiliation: Departments of Family Medicine, Clinical Epidemiology and Biostatistics, Quality Assurance Program Coordinator for Family Medicine Residency, Residency Program Research Coordinator, Family Medicine Residency Program, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Angeles
authors.affiliation: Departments of Family Medicine, Clinical Epidemiology and Biostatistics, Quality Assurance Program Coordinator for Family Medicine Residency, Residency Program Research Coordinator, Family Medicine Residency Program, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Pirrie
authors.affiliation: Departments of Family Medicine, Clinical Epidemiology and Biostatistics, Quality Assurance Program Coordinator for Family Medicine Residency, Residency Program Research Coordinator, Family Medicine Residency Program, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Marzanek
authors.affiliation: Hamilton Paramedic Services, City of Hamilton, Canada.
authors.forename: B
authors.initials: B
authors.lastname: McLeod
authors.affiliation: Departments of Family Medicine, Clinical Epidemiology and Biostatistics, Quality Assurance Program Coordinator for Family Medicine Residency, Residency Program Research Coordinator, Family Medicine Residency Program, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Parascandalo
authors.affiliation: Departments of Family Medicine, Clinical Epidemiology and Biostatistics, Quality Assurance Program Coordinator for Family Medicine Residency, Residency Program Research Coordinator, Family Medicine Residency Program, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Dolovich
mesh_terms: D000058:Accidental Falls / Q000191:economics / Q000517:prevention & control; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control; D003153:Community Health Services / Q000379:methods* / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control; D004634:Emergency Medical Technicians / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006266:Health Education / Q000191:economics / Q000379:methods* / Q000592:standards; D016852:Housing for the Elderly; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D009864:Ontario; D010821:Physicians, Family; D015397:Program Evaluation; D011446:Prospective Studies; D011638:Public Housing; D012017:Referral and Consultation; D018570:Risk Assessment; D012923:Social Class
keywords: Cardiovascular disease; Community paramedicine; Diabetes risk; Elderly; Falls; Intervention; Low income