Introduction & Objective: People living with diabetes face multiple barriers to care and health, including gaps in access to medical care and diabetes self-management education/support (DSMES) and high costs of care. These challenges are particularly great for those living in rural areas. Community paramedics (CPs) are well positioned to deliver DSMES to patients with clinical and psychosocial complexities as part of an interdisciplinary clinical team. CPs are experienced paramedics with advanced training in the management of low acuity and chronic conditions who practice under the supervision of a physical medical director to provide a wide range of services tailored to each patient’s needs. While CP models have emerged across the U.S. and world to support transitional care, CPs have not been leveraged specifically for DSMES.
Methods: D-REM was a pilot pragmatic single-arm prospective trial of a community paramedic (CP) DSMES program that enrolled 70 adults with diabetes, hemoglobin A1c (HbA1c) ≥9%, and recent emergency department or hospital care for any cause. Participants received at-home CP care for approximately one month. Outcomes were ascertained from electronic health record review and postal surveys at 1- and 4-months.
Results: Enrolled participants were 61 (52.3-67.2) years old, 52.9% were men, and 50% lived in rural areas. D-REM resulted in 1.6% improvement in HbA1c, from 9.8% (8.9-10.6) at enrollment to 8.2% (7.1-9.3) at 4 months (p=0/02). It also improved engagement with primary care, endocrinology, and in-clinic DSMES. Participants were highly satisfied with their care.
Conclusion: CP is an emerging and scalable model of care delivery that can support diabetes management for patients experiencing clinical and structural barriers to care. Further research is needed to examine the effectiveness and implementation of CP programs in different settings and populations.
A. Ducharme-Smith: None. R.G. McCoy: Research Support; American Diabetes Association. Other Relationship; American Diabetes Association. Consultant; Wolters Kluwer Health. Research Support; National Institutes of Health, Patient-Centered Outcomes Research Institute. Consultant; Yale New Haven Health System. A.K. Meilander: None. K. Fischer: None. C. Liedl: None. J. Quillen: None. M.B. Juntunen: None.
