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Informing Policy. Advancing Health.

Turning downtime into community time

August 18, 2011

It’s a hard job to provide health care to Colorado’s rural residents when you consider 20 percent of the state’s population is spread across 80 percent of its land. Many of the state’s rural counties face a critical shortage of primary care providers, and the situation promises to worsen as health care reform gives more Coloradans access to insurance. The Western Eagle County Ambulance District, however, is leading the pack in finding an innovative way to maximize available health care services. The district is the first rural area in the nation to adopt a program that expands paramedics’ role in the community.

In late June, a two-year effort gave birth to the Community Paramedic program. Specially trained paramedics who are not needed to respond to emergencies are dispatched to patients’ homes upon physician orders. There, they provide medical care, such as diabetes and blood pressure checks, EKGs and surgical follow-ups, and prevention services. The program serves all of Eagle County. In western Eagle County, about 59 percent of residents are uninsured, and few area doctors accept Medicare or Medicaid.

At last week’s 20th Annual Rural Health Conference, sponsored by the Colorado Rural Health Center, ambulance district chief Chris Montera told attendees the paramedics serve as the “eyes and ears of the physician at home.” Because the paramedics see patients in their own environments, they can watch for and alert the physician to any circumstance that might be affecting the patient’s health or recovery. Kevin Creek, a community paramedic, described a patient who was having difficulty breathing but told her doctor she was taking all her asthma medicines properly. When Creek visited her home, he found an inhaler that was unopened because the patient had erroneously heard that it caused blindness (yes, when sprayed in the eyes).

The Community Paramedic program began in Nova Scotia in 2002 and has only recently started to take root in the United States. To make it work, the program must have the buy-in of physicians, emergency medical providers, hospitals, public health and other health providers, Montera said. The Western Eagle program is a five-year pilot program that includes a partnership with the local health department and Colorado Mountain College.

Services are currently free to residents of the ambulance district, who pay only for costs such as vaccines or lab tests. Funding for the first three years was provided primarily by The Colorado Health Foundation, Caring for Colorado Foundation and the Colorado Department of Public Health and Environment.

Montera hopes an outside evaluation will provide data that show the program results in cost savings to pave the way for seeking reimbursements from Medicare and Medicaid.

What other new ideas is your area trying to bring health care to more people?