What is CP@clinic?

CP@clinic is an innovative, evidence-based chronic disease prevention, management, and health promotion program that seeks to:

Improve older adults’ health and quality of life, and reduce their social isolation
Better connect older adults with primary care, and community resources
Reduce the economic burden of avoidable 911 calls by older adults

  • Locations accessible to large numbers of in-need individuals
  • To date, mostly in the common rooms of subsidized housing buildings
  • Now expanding to other settings such as shelters and community centers

Maria Attends A Typical CP@clinic Session

Maria is 75 and lives alone in her apartment. She has been diagnosed with high blood pressure and uses a walker. Most of her family lives out of town so she doesn’t have many visitors. She leaves her apartment once a week to run errands and do her laundry. She notices the new CP@clinic poster in her apartment lobby and decides to go to a CP@clinic session.

Navigate the banner below to follow Maria through her CP@clinic session.

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    Maria attends CP@clinic on the day and time listed on the poster in the lobby. Maria sees that others in her building are also attending so she sits and waits for her turn.
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    When it’s Maria’s turn, she goes to sit with the paramedic. The paramedic reads through the program details with her and asks her if she would like to participate. Maria asks a few questions and then signs the consent form.
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    The paramedic asks Maria questions about her health and takes her blood pressure, height, weight and waist measurements. The paramedic proceeds to conduct several health assessments.
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    After the assessments, Maria and the paramedic discuss her health risk factors including her blood pressure, risk of diabetes, risk of falling, and medications. The paramedic refers her to her primary care provider and a community falls prevention program. The paramedic writes down her doctor’s phone number and a list of questions she should ask during her appointment.
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    With the paramedic, Maria sets a health goal for this month and records it in her CP@clinic card. She plans to walk up and down her hallway with her walker at least 2 times every day to get more physical activity.
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    The paramedic encourages Maria to come back next month to follow up with her doctor's appointment and her walking goal. Maria writes the next CP@clinic date in her planner.
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    As Maria leaves the common room, some building residents she has never spoken to before invite her to stay for coffee and cards. She decides to join them.

Facts & Figures

CP@clinic is an evidence-based program, meaning that it was derived and informed by research. CP@clinic’s impact was first evaluated in a pilot project and then later in a large research trial and produced very positive results!

CP@clinic Reduces 911 Calls by 19-25%

Elderly man talking on phone while holding his chest

The average number of ambulance calls per month was significantly lower in buildings that had CP@clinic compared to control buildings without CP@clinic, across multiple communities. 

  • 19% less calls in the CP@clinic multi-site randomized controlled trial1 
  • 22% less calls in 3 intervention buildings in Hamilton, ON2  
  • 25% less calls in the CP@clinic pilot study3  

This reduction in 911 calls may allow for the reallocation of ambulances for those who are in greater need

CP@clinic Improves Quality of Life

Happy elderly woman outside with attendant

Those who attended CP@clinic showed significant improvements in:

  • self-care (washing & dressing themselves)1
  • ability to engage in “usual activities”1,2 , and
  • pain and discomfort1

There was a significant QALY gain ranging from 0.05 - 0.15 for those attending CP@clinic sessions1,2
QALYs: Quality-Adjusted Life Years

Improved quality of life can lead to older adults developing better coping skills and increased resiliency

**Quality-adjusted life years (QALYs) are a common measure used to assess whether a drug, intervention, or program can increase or decrease the number of years in good health lived by participants. QALY is defined as one year of life lived in perfect health.4

CP@clinic Reduces Chronic Disease Risk

Woman taking home blood pressure test

Blood pressure: 

  • For participants who had a high BP at their 1st CP@clinic session, 40.5% had their BP normalize after attending several CP@clinic sessions1 
  • For participants who had a high BP at their 1st CP@clinic session, their average BP decreased significantly by 5.0 mmHg systolic and 4.8 mmHg diastolic after the 2nd and 4th sessions. This decrease was sustained across 10 or more visits.2

Diabetes Risk:

  • 50 of 63 or 79% of participants were identified as high risk of developing diabetes in the next 10 years.2  
  • There was an improvement in participants’ diabetes risk after several CP@clinic sessions.1,2  This  demonstrates the positive effects of the tailored health education of CP@clinic in this setting.

CP@clinic Empowers Participants

Elderly couple working outside in a garden

CP@clinic participants are actively engaged in goal setting. Participants set goals for themselves based on their chronic disease risk factors enabling them to take charge of their health

“It keeps you involved in your own health management also right. It brings awareness of health issues.” -CP@clinic Participant 5

Connects to Primary Care

Young female doctor checking patient's heart
  • 715 of 794, or 90% of residents who attended CP@clinic were provided with health education and directed towards their family physician for chronic disease risks1
  • 95%, or 755 of 794 participants had regular reports with their CP@clinic assessment results faxed to participants’ primary care providers potentially enabling them to receive optimal care1

Cost Effective

Infographic showing Net Gain of $128,120
  • CP@clinic is Proven to be Cost-effective. Benefit to Cost Ratio of 2:1 - For every $1 spent on the CP@clinic Program, the Emergency Care System sees $2 in benefits6
  • Using data from the CP@clinic Randomized Controlled Trial in 13 social housing buildings with 1461 residents6
  • Watch the Cost-Effectiveness of CP@clinic Infographic Video for more information.
  1. Agarwal G, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J, Thabane L. (2019). 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. Prehospital Emergency Care. 23(5): 718-729.
  2. Agarwal G, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J. (2018). Evaluation of a Community Paramedicine Health Promotion and Lifestyle Risk Assessment Program in Seniors Living in Social Housing Buildings: A Cluster Randomized Trial. CMAJ. 190(21): E638-E647
  3. Agarwal G, Angeles R, Pirrie M, Marzanek F, McLeod B, Parascandalo J, Dolovich L. (2017). 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).BMC Emergency Medicine. 17(8): 1-8.
  4. Cape, J.D., Beca, J.M., and Hoch, J.S. (2013). Introduction to Cost-Effectiveness Analysis for Clini-cians. University of Toronto Medical Journal, 90(3). Accessed from http://healtheconomics.utoronto.ca/wp-content/uploads/1493-2720-2-PB3.pdf
  5. Brydges M, Agarwal G, Denton M. (2016). The CHAP-EMS health promotion program: a qualitative study on participants' views of the role of paramedics. BMC Health Service Research. 16(435): n/a.
  6. 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;10:e037386. doi: 10.1136/bmjopen-2020-037386

Infographics

Health Canada Support

CP@clinic Scale-Up Supported by Health Canada

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A model of care proven to reduce EMS calls — which frees up ambulances for quicker response times and may help reduce the burden on emergency departments — is expanding to sites across Canada.

Group photo of CP@clinic team

Dr. Gina Agarwal and the McMaster Community Paramedicine Research Team have been awarded Health Care Policy Contribution Program (HCPCP) funding by Health Canada to expand the innovative Community Paramedicine at Clinic (CP@clinic) program with paramedic services across Canada. CP@clinic is the leading evidence-based community paramedicine wellness clinic model and has the potential to benefit communities across Canada.

CP@clinic is already well-established in Ontario implemented by 17 paramedic services in their local communities. The funding from Health Canada will allow Agarwal and her team to adapt CP@clinic to the unique needs and contexts of communities across the country and to develop the infrastructure necessary to run a sustainable program in multiple provinces.

“Working with our paramedic services partners, we have tested and improved the CP@clinic model with a broad spectrum of urban and rural communities in Ontario,” says Agarwal. “This new funding is going to help us develop locally relevant instances of the program with paramedic services across Canada.” 

CP@clinic Publications

2023

Perceived value and benefits of the Community Paramedicine at Clinic (CP@clinic) programme: a descriptive qualitative study.

Authors:
Francine Marzanek, Kalpana Nair, Andrea Ziesmann, Aarani Paramalingam, Melissa Pirrie, Ricardo Angeles, Gina Agarwal

Reference:

Marzanek F, Nair K, Ziesmann A, Paramalingam A, Pirrie M, Angeles R, Agarwal G. (2023). Perceived value and benefits of the Community Paramedicine at Clinic (CP@clinic) programme: a descriptive qualitative study. BMJ Open, 13:e076066. doi: 10.1136/bmjopen-2023-076066.
2023

Challenges in Recruiting Frequent Users of Ambulance Services for a Community Paramedic Home Visit Program.

Authors:
Mikayla Plishka, Ricardo Angeles, Melissa Pirrie, Francine Marzanek, Gina Agarwal

Reference:

Plishka M, Angeles R, Pirrie M, Marzanek F, Agarwal F. (2023). Challenges in Recruiting Frequent Users of Ambulance Services for a Community Paramedic Home Visit Program. BMC Health Services Research, 23:1091. doi: 10.1186/s12913-023-10075-9
2023

The Most Common Self-Reported Reasons for Calling EMS: A Cross-Sectional Survey of Frequent Callers in Ontario.

Authors:
Ricardo Angeles, Brent McLeod, Janice Lee, Sabnam Mahmuda, Alix Stocic, Michelle Howard, Gina Agarwal

Reference:

Angeles R, McLeod B, Lee J, Mahmuda S, Stocic A, Howard M, Agarwal G. (2023). The Most Common Self-Reported Reasons for Calling EMS: A Cross-Sectional Survey of Frequent Callers in Ontario. International Journal of Paramedicine, 4: 29-39.
2023

Adapting the Community Paramedicine at Clinic (CP@clinic) program to a remote northern First Nation community: A qualitative study of community members’ and local health care providers’ views.

Authors:
Amelia Keenan, Pauneez Sadri, Francine Marzanek, Melissa Pirrie, Ricardo Angeles, Gina Agarwal

Reference:

Keenan A., Sadri P., Marzanek F., Pirrie M., Agarwal G. (2023). Adapting the Community Paramedicine at Clinic (CP@clinic) program to a remote northern First Nation community: A qualitative study of community members’ and local health care providers’ views. International Journal of Circumpolar Health.
2023

2022

Paramedics’ perspectives of the community paramedic role in Ontario, Canada.

Authors:
Gina Agarwal, Melissa Pirrie, Ricardo Angeles, Francine Marzanek, Amelia Keenan, Brent McLeod, Krista Cockerell, Buck Reed

Reference:

Agarwal G, Pirrie M, Angeles R, Marzanek F, Keenan A, McLeod B, Cockerell K, Reed B. (2022). Paramedics’ perspectives of the community paramedic role in Ontario, Canada. Journal of Paramedic Practice, 14(11). doi: 10.12968/jpar.2022.14.11.464.
2022

Health knowledge and self-efficacy to make health behaviour changes: a survey of older adults living in Ontario social housing.

Authors:
Jasmine Dzerounian, Melissa Pirrie, Leena AlShenaiber, Ricardo Angeles, Francine Marzanek, Gina Agarwal

Reference:

Dzerounian J, Pirrie M, Al Shenaiber L, Angeles R, Marzanek F, Agarwal G. (2022). Health knowledge and self-efficacy to make health behaviour changes: a survey of older adults living in Ontario social housing. BMC Geriatrics, 22(1):473. doi: 10.1186/s12877-022-03116-1.
2022

Workplace violence against Emergency Health Care Workers: What Strategies do Workers use?

Authors:
Evelien Spelten, Julia van Vuuren, Peter O’Meara, Brodie Thomas, Mathieu Grenier, Richard Ferron, Jennie Helmer, Gina Agarwal

Reference:

Spelten E, van Vuuren J, O’Meara P, Thomas B, Grenier M, Ferron R, Helmer J, Agarwal G. (2022). Workplace violence against Emergency Health Care Workers: What Strategies do Workers use? BMC Emergency Medicine. https://doi.org/10.1186/s12873-022-00621-9.
2022

Integrating community paramedicine with primary health care: A qualitative study of community paramedic views.

Authors:
Gina Agarwal, Amelia Keenan, Melissa Pirrie, Francine Marzanek

Reference:

Agarwal G, Keenan A, Pirrie M, Marzanek-Lefevbre F. (2022). Integrating community paramedicine with primary health care: A qualitative study of community paramedic views. CMAJ Open 2022, 10(2):E331-E337. doi: 10.9778/cmajo.20210179.
2022

2021

The effect of COVID-19 on emergency medical service call volumes and patient acuity: a cross-sectional study in Niagara, Ontario.

Authors:
Richard Ferron, Gina Agarwal, Rhiannon Cooper, Douglas Munkley

Reference:

Ferron R, Agarwal G, Cooper R, Munkley D. (2021). The effect of COVID-19 on emergency medical service call volumes and patient acuity: a cross-sectional study in Niagara, Ontario. BMC Emergency Medicine, 21 (39). https://doi.org/10.1186/s12873-021-00431-5.
2021

Economic Analysis of Mobile Integrated Health Care Delivered by Emergency Medical Services Paramedic Teams.

Authors:
Feng Xie, Jiajun Yan, Gina Agarwal, Richard Ferron

Reference:

Xie F, Yan J, Agarwal G, Ferron R. (2021). Economic Analysis of Mobile Integrated Health Care Delivered by Emergency Medical Services Paramedic Teams. JAMA Network Open, 4(2):e210055. https://doi.org/10.1001/jamanetworkopen.2021.0055
2021

Economic Analysis of Mobile Integrated Health Care Delivered by Emergency Medical Services Paramedic Teams

Authors:
Xie F, Yan J, Agarwal G, Ferron R*.

Reference:

JAMA Network Open. 4(2)
2021

Paramedics working in general practice: a scoping review

Authors:
Xi D, McCombe G, Agarwal G, et al.

Reference:

HRB Open Res.
2021

Reshaping healthcare delivery for elderly patients: the role of community paramedicine; a systematic review

Authors:
Van Vuuren J, Thomas B, Agarwal G, MacDermott S, Kinsman L, O’Meara P, Spelten E.

Reference:

BMC Health Services Research. 21 (29).
2021

Social isolation in older adults residing in social housing in Ontario: a cross-sectional study.

Authors:
Agarwal G, Pirre M*, Gao A*, Angeles R, Marzanek F

Reference:

CMAJ Open
2021

Time to reshape our delivery of primary care to vulnerable older adults in social housing?

Authors:
Agarwal G, Pirrie M*, Marzanek F, Angeles R.

Reference:

British Journal of General Practice. 71 (702): 6-7
2021

2020

Cost-effectiveness analysis of a community paramedicine programme for low-income seniors living in subsidised housing: the community paramedicine at clinic programme (CP@ clinic)

Authors:
Agarwal G, Pirrie M, Angeles R, Marzanek F, Thabane L, O'Reilly D.

Reference:

BMJ Open 2020;10:e037386. doi: 10.1136/bmjopen-2020-037386
2020

Feasibility of implementing a community cardiovascular health promotion program with paramedics and volunteers in a South Asian population.

Authors:
Agarwal G, Bhandari M, Pirrie M, Angeles R, Marzanek F.

Reference:

BMC Public Health. 2020 Oct 27;20(1):1618.
2020

Poverty and food insecurity of older adults living in social housing in Ontario: a cross-sectional study

Authors:
Pirrie, M., Harrison, L., Angeles, R., Marzanek, F., Ziesmann, A., & Agarwal, G.

Reference:

BMC Public Health, 20(1), 1320. https://doi.org/10.1186/s12889-020-09437-3
2020

Type 2 diabetes risk in older adults living in social housing: A cross-sectional study.

Authors:
Angeles R, Zhu Y, Pirrie M, Marzanek F, Agarwal G.

Reference:

Canadian Journal of Diabetes [Internet]. 2020 Oct 15 [cited 2020 Nov 11];0(0). Available from: https://www.canadianjournalofdiabetes.com/article/S1499-2671(20)30413-5/abstract
2020

Understanding Why Frequent Users of EMS Call 9-1-1: A Grounded Theory Study.

Authors:
Mahmuda S, Wade-Vallance A, Stosic A, Guenter D, Howard M, Agarwal G, Angeles R.

Reference:

Health Promotion Practice, 21(3), 440-447.
2020

2019

Community Paramedicine: A Systematic Review of Program Descriptions and Training.

Authors:
Chan J,* Agarwal G.

Reference:

Canadian Journal of Emergency Medicine.
2019

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.

Authors:
Agarwal G, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J, Thabane L.

Reference:

Prehospital Emergency Care. 23(5): 718-729.
2019

Social factors in frequent callers: a description of isolation, poverty, and quality of life in those calling emergency medical services frequently.

Authors:
Agarwal G, Lee J, McLeod B, Mahmuda S*, Howard M, Cockrell K, Angeles R.

Reference:

BMC Public Health. 19: 684
2019

What do community paramedics assess? An environmental scan and %content analysis of patient assessment in community paramedicine.

Authors:
Leyenaar, M., McLeod, B., Penhearow, S., Strum, R., Brydges, M., Mercier, E., Nrousseau, A., Besserer, F., Agarwal, G., … [et al.]

Reference:

CJEM, 21(6), 766-775. doi:10.1017/cem.2019.379
2019

2018

Assessing Health Literacy Among Older Adults Living in Subsidized Housing: A Cross Sectional Study.

Authors:
Agarwal G, Habing K, Pirrie M, Angeles R, Marzanek F, Parascandalo J.

Reference:

Canadian Journal of Public Health. 109(3): 401-409.
2018

Evaluation of a Community Paramedicine Health Promotion and Lifestyle Risk Assessment Program in Seniors Living in Social Housing Buildings: A Cluster Randomized Trial.

Authors:
Agarwal G, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J.

Reference:

CMAJ. 190(21): E638-E647.
2018

2017

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)

Authors:
Agarwal G, Angeles R, Pirrie M, Marzanek F, McLeod B, Parascandalo J, Dolovich L.

Reference:

BMC Emergency Medicine. 17(8): 1 - 8.
2017

2016

Examining hypertension rates, severity, knowledge, and modifiable risk factors in older adults residing in Ontario subsidised housing.

Authors:
Agarwal G, McDonough B, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J, Dolovich L

Reference:

Canadian Journal of Cardiology. 31(10): S50.
2016

The CHAP-EMS/CP@clinic health promotion program: a qualitative study on participants’ views of the role of paramedics.

Authors:
Brydges M, Agarwal G, Denton M.

Reference:

BMC Health Service Research. 16(435): n/a.
2016

2014

Effectiveness of a Community Health and Wellness Pilot in a Subsidized Seniors’ Apartment Building: CHAP-EMS/CP@clinic

Authors:
Agarwal G, Angeles R, McDonough B, McLeod B, Marzanek F, Pirrie M, Dolovich L

Reference:

CHAP-EMS. Canadian Journal of Diabetes. 38(5): S72.
2014