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

Infographic on the 2018 publication from the VIP Lab  in the Canadian Medical Association Journal, or CMAJ. On the top left is text that says Canadian Medical Association Journal CMAJ Research. Vulnerable populations. Below this is an icon of a trophy and text that says CIHR Institute of Health Services and Policy Research IHSPR 2019 Article of the year. At the top right is the title of the article, which is Evaluation of a community paramedicine health promotion and lifestyle risk assessment program for older adults who live in social housing, a cluster randomized trial. Below this says read full article online at bit dot LY forward slash CMAJ2018. Below the title banner is another banner that reads Community paramedicine at clinic or CP at clinic is a chronic disease prevention, management, and health promotion program for older adults held in subsidized apartment buildings by trained paramedics. Below this banner to the left is a title that says characteristics of residents who completed the baseline survey. The demographics are divided by Intervention n equals 129 and Control n equals 129. The demographics listed are as follows. 74 is the mean age in Intervention, 71 in control. 76 percent of intervention and 74 percent of control are female. 51 percent of intervention and 47 percent of control have some high school or less. 84 percent of intervention and 82 percent of control have poor health literacy. 89 percent of intervention and 92 percent of control live alone. 99 percent of intervention and 98 percent of controls have moderate to high risk of diabetes. Below these demographics is text that says the CP at clinic intervention had a significant effect on mean monthly ambulance calls and a greater improvement in Quality Adjusted Life years or QALYs in intervention buildings compared to control buildings. To the right of the demographics and this text is a diagram showing the flow vertically from study results to methods. At the top, text says pragmatic cluster randomized controlled trial. From this text there are two arrows. One arrow branches to the left and down and the other to the right and down. On the left the arrow points to the CP at clinic logo, text that says 3 Intervention, and an icon of 3 apartment buildings overlaid with text that says 455 residents. On the left, the arrow points to the CP at clinic logo with an X over it, text that says 3 Control, and an icon of 3 apartment buildings overlaid with text that says 637 residents. Under these diagrams is a horizontal line with two vertical branches, one directly beneath each icon of 3 apartment buildings. Beneath these branches is a box with a summary of results. On the top far left of the box is a bubble with an icon of an ambulance with text that says 9 1 1 calls, and under that is a bubble with an icon of a smiley face and text that says quality of life. Directly below the branches reaching from the 3 Intervention building apartment icons and 3 Control building apartment icons is text that says, respectively, 3.11 calls per 100 units per month and 3.99 calls per 100 units per month. Between these two results is text that says p less than 0.01. Below these results from left to right, beside the quality of life icon and smiley, is an arrow pointing upward and text that says 0.15 QALY, text that says p less than 0.05, and an arrow pointing upward that says 0.06 QALY. At the bottom of the box says QALY equals Quality adjusted life years. Across the bottom of the infographic from left to right are the logos for the McMaster University Department of Family Medicine, Hamilton Paramedic Services, City Housing Hamilton, the Canadian Institute for Health Research, and Hamilton Academic Health Sciences Organization. Below these logos is text that says author names, which are Gina Agarwal, Ricardo Angeles, Melissa Pirrie, Brent McLeod, Francine Marzanek, Jenna Parascandalo, Lehana Thabane.

Canadian Medical Association Journal

Intervention buildings where the CP@clinic Program was implemented had significantly fewer monthly ambulance calls and a greater improvement in older adults’ Quality Adjusted Life Years when compared to Control buildings in our pragmatic cluster-randomized controlled trial.
Infographic explaining the published article from the VIP Lab in Prehospital Emergency Care. The top banner has text that says Prehospital Emergency Care. 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. Read full article online at bit dot ly forward slash CP at Clinic RCT. Below the title banner is a smaller banner that has text which says Community Paramedicine at clinic or CP at clinic is a chronic disease prevention, management, and health promotion program for older adults held in subsidized apartment buildings by trained paramedics. Below this banner is a number of graphics and statistics. On the top left of that space below the banner is a box titled characteristics of residents who completed the baseline survey. On the left of the box is a column labelled Intervention n equals 358 and on the right is a column labelled Control n equals 320. The statistics organized in these columns are labelled as follows from top to bottom. Mean age is 74 in intervention, 71 in control. Female is 80 percent in intervention, 72 percent in control. Some high school or less is 45 percent in intervention, 46 percent in control. Poor health literacy is 84 percent in intervention, 82 percent in control. Lives alone is 91 percent in intervention, 90 percent in control. Moderate to high risk of diabetes is 98 percent in intervention, 96 percent in control. Below this box of characteristics is a bubble with text at the top of it that says thank you to our partners. Under the text are logos for the following services from left to right, top to bottom. York region paramedic services, York region, Hamilton paramedic services, city housing hamilton, guelph wellington paramedic services, the corporation of the county of wellington, greater Sudbury paramedic services, Sudbury housing, The County of Simcoe, and county of Simcoe health and emergency services. On the right side of the infographic is a diagram showing the flow of the project from study methods at the top to study results at the bottom. The top has text that says pragmatic cluster randomized controlled trial. Below this is a box that says 5 communities and has two arrows branching away from it. One arrow branches to the left and down, and the other branches to the right and down. The arrow on the left points to the CP at clinic logo, an icon of apartment buildings, and text that says 15 intervention, 2009 residents. The arrow on the right points to the CP at clinic logo with an X overlaying it, an icon of apartment buildings, and text that says 15 control, 2072 residents. Below all these icons and text is a horizontal line with a vertical branch pointing down from the text that says 15 intervention, and a vertical branch pointing down from the text that says 15 control. Below the branch from 15 intervention there is a bubble that says 19.4 percent reduction in EMS calls and text that says 3.73 calls per 100 units per month. Below the branch from 15 control is text that says 4.64 calls per 100 units per month. Between the two branches is an icon of an ambulance with text that says 911 calls and text that says p equals 0.006. Below the text that says 3.73 calls per 100 units per month is text that says 0.05 QALY and an icon of an arrow pointing up. Below the text that says 4.64 calls per 100 units per month is text that says 0.01 QALY and an icon of a smaller arrow pointing up. Between the two arrows pointing up is a smiley icon with text that says quality of life and text that says p equals 0.004. Below that is text that says QALY equals Quality adjusted life year. There is a large arrow pointing from the bubble that says 19.4 percent reduction in EMS calls to a box that is titled Impact of CP at clinic on participants. In the box there is an icon of a blood pressure cuff and text that says participants with high blood pressure or BP improved and had normal BP on follow up, a thumbs up icon with text that says improved activities of daily living, less pain and discomfort, and an icon of a hand holding a handheld glucometer with text that says lower diabetes risk scores. Below this box is the logo for the McMaster University Department of Family Medicine and the logo for the Canadian Institute of Health Research. The bottom of the infographic has text that says Publication authors which are Gina Agarwal, Ricardo Angeles, Melissa Pirrie, Brent McLeod, Francine Marzanek, Jenna Parascandalo, Lehana Thabane.

Prehospital Emergency Care

Intervention buildings where the CP@clinic Program was implemented had a 19.4% reduction in EMS calls, and participants had improved health outcomes for Quality Adjusted Life Years, blood pressure, activities of daily living, pain, and diabetes risk when compared to Control buildings in our pragmatic cluster-randomized controlled trial.
Infographic titled Introducing the community paramedicine at home program CP at home. The title banner includes the mcmaster department of family medicine logo and the mcmaster community paramedicine logo. The top left shows the CP at clinic logo next to an icon of an apartment building. Underneath that says the community paramedicine at clinic or Cp at clinic program is innovative, evidence based, and cost effective. A chronic disease prevention, management, and health promotion program. Held in common spaces in social housing buildings. Offered on a drop in basis. To the right of this blurb is an arrow pointing to the right that says adapted to be delivered in patients homes. To the right of the arrow is a similar blurb with the CP at home logo next to an icon of a house. Underneath this is text that says the CP at clinic program has been adapted to be delivered as an in home visit, referred to as CP at home. CP at home features all of the same assessments slash tools that are familiar to CP at clinic community paramedics. Underneath these blurbs is a series of interlocking hexagons shapes. The hexagon furthest to the left says populations that can benefit from CP at home. The following hexagons from left to right list the populations as individuals with multiple chronic conditions, vulnerable and frail older adults, individuals with limited mobility, populations prioritized by the Ontario Health Teams, individuals on the Long Term Care waitlist, individuals referred by paramedics which includes frequent callers, individuals receiving remote patient monitoring, and individuals referred by hospital discharge planner, for example at risk for readmission. To the bottom left of this is a list of benefits of the CP at home program which are improved patient quality of life, identifying and managing chronic diseases, help patients stay healthy at home, educating and empowering patients to look after themselves, and connecting back to primary care. To the right of this is a list of features of the out of the box CP at home program, which are evidence based program grounded in 10 years of robust research, standardized online paramedic training, uses appropriate validated assessment tools slash questionnaires, standardized electronic database with decision support, standardized reports for monitoring and quality assurance, and customized impact reports for services needs. Underneath benefits and features there are three bubbles with arrows pointing to the right between them. The bubble furthest to the left says CP at home first visit, completion of patient intake assessments. The middle bubble says CP at home follow up visit, patient check ins with assessments as needed. The bubble on the right says CP at home program discharge, definite end point for in home visits. At the bottom is the Twitter handle at CP at clinic, and website cp at clinic dot CA.

CP@home

Older adults on the Long-Term Care waitlist or who have limited mobility are just some of the populations who can benefit from CP@clinic delivered as a home visit, also known as CP@home.
Virtual CP at clinic infographic. The top right corner has the McMaster Department of Family Medicine and McMaster Community Paramedicine logos. Top banner says CP at clinic has responded and adapted to the COVID 19 pandemic and has been adapted. The program has specific components supported by a smart database for program implementation. Below this says Three options for your paramedic service to implement the Virtual CP at clinic Program for your community. Underneath this text are the three options. From left to right are 1. no in person contact, phone slash video call, and an icon of a video camera and an icon of a mobile phone. 2. some in person, phone slash video call and in person appointment, and icons of a video camera, mobile phone, and monthly calendar page. 3. All in person, in person appointment, and an icon of a monthly calendar page. Below these is a banner that says Why virtual CP at clinic is needed. Underneath the banner are four bubbles. The first bubble has an icon of a mobile phone and says Technology disparities, inequity in access to healthcare and basic needs is more prevalent due to shift to online care. The second bubble has an icon of a pair of hands holding a heart with a first aid cross in it and says Chronic disease management, continued health monitoring is more important than ever due to recent increases in healthcare system stress. The third bubble has an icon of an older adult sitting at a table in a small house and says Social isolation, the pandemic has increased social isolation which is related to negative physical and mental health outcomes. The fourth bubble has an icon of three people with their heads and shoulders side by side and says Vulnerable populations, to many, this program could be a crucial lifeline to maintain overall health and wellbeing. At the bottom left of the infographic are three badges that respectively say Supported by 10 years of robust research, product of McMaster University, endorsed by Health Canada. The bottom right has contact information that says Contact us for more information and or if you are interested in the Virtual CP at clinic program. email admin at CP at clinic dot CA, website cp at clinic dot CA, Twitter handle at CP at clinic.

Virtual CP@clinic

To protect paramedics and patients during the COVID-19 pandemic, Virtual CP@clinic can be implemented with no in-person contact, some in-person contact, or all in-person contact.
Infographic titled Cost effectiveness of the CP at clinic Program. Data from the CP at clinic multi site randomized controlled trial. Beside the top title is an icon of two older persons walking outside of an apartment complex. Under the title on the top left is a box with text that says for every one dollar spent on the CP at clinic program, the emergency care system sees 2 dollars in benefits. There is an asterisk at the end of the sentence. The asterisk is explained below the box by text that says based on 13 social housing buildings and 1461 residents. Under the box are two bubbles side by side. The bubble on the left has an icon of an ambulance and text that says Net savings per resident, 88 dollars. The bubble on the right has an icon of an arrow pointing down with a dollar sign overlaid on it, and text that says program cost per QALY is well below the threshold for program adoption in Canada. Below this bubble is text that says QALY equals quality adjusted life year. On the right side of the infographic is an icon of a set of weighing scales. The base of the scales has text that says 2 to 1 benefit to cost ratio and net gain equals 128,120 dollars. There is a box to the right of the scales that says key and shows a small bubble equals ten thousand dollars. Both sides of the scale have several bubbles represented by ten thousand dollars on them. On the left side there is text above the scale that says benefits, total benefits equals 256,582 dollars. This left side of the scale has several bubbles on it and is lower than the right side of the scale, which has fewer bubbles. Beside the left side of the scale is text that says EMS call reduction is 256,582 dollars. Above the right side of the scale is text that says costs, total costs equals 128,462 dollars. Beside the scale, which has fewer bubbles than the left side, there is text that says printed materials, 1,265 dollars, equipment, 9,635 dollars, IT slash Tech, 3,940 dollars, Staffing, 31,130 dollars, Supervision, 32,522 dollars, Vehicle, 50,000 dollars. The bottom right of the infographic has the McMaster University Department of Family Medicine logo, and the bottom left has the citation which is 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 at clinic BMJ Open 2020 10 e037386. DOI 10.1136 forward slash bmj open hyphen 2020 hyphen 037386

Cost-effectiveness of CP@clinic

CP@clinic has a 2:1 benefit to cost ratio - For every $1 spent on the CP@clinic Program, the Emergency Care System sees $2 in benefits.
Infographic with title at the top left which reads Feasibility study adapting and implementing CP at clinic for a South Asian population. The top right has the CP at clinic logo. On the left under the title there is an icon of a checklist and stethoscope beside text that says 26 CP at clinic sessions with paramedics, and icon of three people with their heads and shoulders beside text that says 71 participants, predominantly male and South Asian, an icon of a temple beside text that says 52 participants at the Sikh temple, an icon of a large house beside text that says 19 participants at the recreation centre, and an icon of two chat bubbles beside text that says volunteers provided translation in Hindi, Punjabi, and Urdu. The right side of the infographic has text that says implementing the CP at clinic program in places of worship is a feasible approach to adapting the program for a South Asian population. In the future, a funded translator plus the volunteers would make the program more sustainable. There is substantial opportunity for addressing risk factors in this population using the CP at clinic program. The bottom left corner of the infographic has the logo for McMaster Community Paramedicine Research, and the following citation. Agarwal G, Bhandari M, Pirrie M, Angeles R, Marzanek F. Feasibility of implementing a community cardiovascular health promotion program with paramedics and volunteers in a South Asian population. BMC Public Health 2020 20, 1618. The bottom right of the infographic has the logo for the McMaster University Department of Family Medicine.

Feasibility of implementing CP@clinic with volunteers in a South Asian Population

Adapting CP@clinic with volunteer translators for a Canadian South Asian population in a temple shows promise as an opportunity to address cardio-metabolic risk factors.
Infographic with title at the top left which reads Type 2 diabetes risk in older adults living in social housing in Ontario. Beside the title is the logo for McMaster Community Paramedicine Research. Below the title on the left side of the infographic is an icon of a heart with an electrocardiogram reading on it beside text that says at baseline 12.5 percent of the participants were previously diagnosed with diabetes, an icon of a checklist beside text that says using a risk screening tool among those participants not previously diagnosed with diabetes, 96.7 percent had moderate to high risk of developing diabetes, and an icon of a hand with the pointer finger extended accompanied by a drop of blood labelled with a plus and minus sign beside text that says based on a blood glucose test, 32 percent of participants might have undiagnosed diabetes or prediabetes, signaling a higher burden of disease than what is currently known. Below this is text that says older adults living in social housing are vulnerable populations with poorer health status and higher risk of developing prediabetes and diabetes. On the top right of the infographic is text that says Study participants. 728 older adults living in social housing buildings in Ontario. Below this title there is an icon of a pie chart and accompanying text indicating 80.5 percent are female, another icon of a pie chart and accompanying text indicating 85.4 percent are white, and another pie chart and accompanying text indicating 69.2 percent have a high school diploma or less. The bottom left of the infographic has the McMaster University Department of Family Medicine logo, and the following citation. Angeles R, Zhu Y, Pirrie M, Marzanek F, Agarwal G. Type 2 diabetes risk in older adults living in social housing, A cross sectional study. Canadian Journal of Diabetes 2020. The bottom left of the infographic has the CP at clinic logo.

Type 2 diabetes risk in older adults living in social housing

The burden of disease among older adults in social housing is higher than we know: 1/3 of CP@clinic participants may have undiagnosed prediabetes or diabetes.
 Infographic titled poverty and food insecurity, older adults living in social housing in Ontario. Beside the title is the CP at clinic logo. Below the title to the left is text that says Study participants, 806 older adults living in social housing buildings in Ontario. Below this text is a pie chart and accompanying text indicating 78 percent live alone, another pie chart and accompanying text indicating 44 percent have not completed high school, and another pie chart and accompanying text indicating 70 percent are female. In the top middle of the infographic is a bar graph with one bar reaching halfway up the y axis and another bar reaching all the way up the y axis, but cut in half horizontally and the top half is askew. Next to the bar graph is text that says people living in social housing face double food insecurity rates compared to older adults in the general public. Below this is text that says people who did report being food secure were still more likely to report poor dietary habits than the general public. Below this is an icon of three hamburgers and text that says most eat high fat or fast food at least once a week. 10 percent eat it more than 3 times per week. On the right of the infographic is a bubble with a title above it that says Experience of poverty. Inside the bubble is text that says 14 percent have trouble making ends meet at the end of the month. The bottom of the infographic has the McMaster University Department of Family Medicine logo and the following citation. Pirrie M, Harrison L, Angeles R, Marzanek F, Ziesmann A, Agarwal G. Poverty and food insecurity of older adults living in social housing in Ontario, a cross-sectional study. BMC Public Health 2020 20 1320

Poverty and food insecurity of older adults living in social housing in Ontario

People living in social housing in Ontario are twice as likely to be food insecure as the general public.

Health Canada Support

CP@clinic Scale-Up Supported by Health Canada

Image Image Image

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

Pirrie, M., Saini, G., Angeles, R. et al. (2020). Risk of falls and fear of falling in older adults residing in public housing in Ontario, Canada: findings from a multisite observational study.BMC Geriatr 20, 11.

Chan J, Griffith L, Costa AP, Leyenaar M, Agarwal G. (2019). Community Paramedicine: A Systematic Review of Program Descriptions and Training. Canadian Journal of Emergency Medicine

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.

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.

Agarwal G, Habing K, Pirrie M, Angeles R, Marzanek F, Parascandalo J. (2018). Assessing Health Literacy Among Older Adults Living in Subsidized Housing: A Cross Sectional Study. Canadian Journal of Public Health. 109(3): 401-409.

Agarwal G, Brydges M. (2018). Effects of a Community Health Promotion Program on Social Factors in a Vulnerable Older Adult Population residing in Social Housing. BMC Geriatrics. 18(1): 95.

 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.

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.

Agarwal G, McDonough B, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J, Dolovich L. (2016). Examining hypertension rates, severity, knowledge, and modifiable risk factors in older adults residing in Ontario subsidised housing. Canadian Journal of Cardiology. 31(10): S50.

Agarwal G,Angeles R, McDonough B, McLeod B, Marzanek F, Pirrie M, Dolovich L. (2015). Development of a community health and wellness pilot in a subsidised seniors’ apartment building in Hamilton, Ontario: Community Health Awareness Program delivered by Emergency Medical Services (CHAP-EMS). BMC Research Notes. 8(8): 113.

Agarwal G, McDonough B, Angeles R, Pirrie M, Marzanek F, McLeod B, Dolovich L. (2015). Rationale and methods of a multicentre RCT of the effectiveness of a Community Health Assessment Program with Emergency Medical Services (CHAP-EMS)implemented on residents aged 55 years and older in subsidised seniors’ housing buildings in Ontario. BMJ Open. 5(6): e008110.

Agarwal G, Angeles R, McDonough B, McLeod B, Marzanek F, Pirrie M, Dolovich L. (2014). Effectiveness of a Community Health and Wellness Pilot in a Subsidized Seniors' Apartment Building: CHAP-EMS. Canadian Journal of Diabetes. 38(5): S72.

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
Agarwal G, Bhandari M, Pirrie M, Angeles R, Marzanek F. Feasibility of implementing a community cardiovascular health promotion program with paramedics and volunteers in a South Asian population. BMC Public Health. 2020 Oct 27;20(1):1618.
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