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

The data is collected in a secure database that is synced regularly from each program site to McMaster University
The McMaster University Community Paramedicine Research Team analyses the data to prepare reports for Paramedic Services and other CP@clinic partners
Paramedic services can use this data for program quality improvement (QI)
The data is also used to prepare academic publications to share the findings with other researchers

Health Canada has provided funding to scale up the CP@clinic research intervention to a national Canada wide program.The scale up of CP@clinic will feature a revision of its materials, including website, training modules, program guide, and toolkit. This revision will transition the materials from a research project to a sustainable community-based health program. It will also include IT infrastructure and adaptations to different populations, including a full translation of all materials into French.

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.

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.
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.
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.
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.
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.
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.
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 sessions^1,2
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

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.

Watch Infographic Video

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, 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.
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
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, 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

Paramedics’ Perspectives on the Community Paramedic Role in Ontario

This study was a cross-sectional, web-based survey of Ontario paramedics that measured perceptions, support, interest, and training in Community Paramedicine (CP).
Data ownership and security for CP@clinic

Who owns CP@clinic data? And how is it kept secure?
Tsunami of Neglected Health Conditions

We are starting to feel the impact of the COVID-19 pandemic in the form of increasing mental and psychological health concerns, social isolation, undetected/untreated chronic diseases, canceled health care, and lack of primary care access which can be addressed by CP@clinic in your community.
Beneath the Tip of the Pandemic Iceberg

What is hidden beneath the pandemic iceberg?
The Community Paramedicine at Clinic (CP@clinic) Program

The CP@clinic Program is an innovative and evidence-based program to address the high 911 call rate and high needs of the vulnerable population of older adults living in social housing.
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.
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.
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@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.
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.
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.
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.
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

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.

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

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-2020-0373862020

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/s12889-020-09437-32020

Risk of falls and fear of falling in older adults residing in public housing in Ontario, Canada: findings from a multisite observational study.

Authors:

Pirrie, M., Saini, G., Angeles, R. et al.

Reference:

BMC Geriatr 20, 11.2020

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/abstract2020