Rural health care moves out of emergency rooms, into homes

Published by The Durango Herald
Reid Wright
January 1, 2012

As the demographic population of Colorado ages and doctors are stretched thin, nurses and medical assistants have taken on an expanded role in providing health care.

Rural health-care providers are studying a new concept that also expands the role of emergency medical personnel.

Emergency medical responders in Montezuma County listened to a presentation last week from Eagle County health-care providers about their community paramedic program — a new program that aims to have emergency medical personnel provide health care to patients in their home before an emergency arises.

The Southwest Memorial Hospital emergency medical team is studying the program as a possible model.

Christopher Montera, chief of the Western Eagle County Ambulance District, said the program is particularly helpful where doctors are scarce.

Montezuma County was recently designated as an area deficient of primary health-care providers by the U.S. Department of Health and Human Services.

Too many patients go to the emergency room for primary care, he said. As many as 80 percent of emergency-room visits are for nonemergency treatment. This generally winds up costing three times more than a visit to a doctor's office.

The program model uses paramedics — already trained in basic health monitoring — to perform home checks on patients who have a serious illness, but don't require constant home care.

For example, Montera told the story of a community paramedic visiting an older woman suffering from respiratory problems who was too sick to make it to her doctor's appointment that day. The paramedic enters her home to find the woman in a living room chair. She claims she is taking all of her medications but he finds out she had, in fact, stopped taking the inhaler because she had seen a news report saying it causes blindness.

The community paramedic convinced the woman it was all right for her to use the inhaler and said he would check back in two weeks. Montera believes that if it had not been for the community paramedic's visit, the woman would have become worse until she needed an expensive ambulance ride, emergency-room visit and possibly a stay in the intensive-care unit.

"One of the hallmarks of this program is being in the home — and being the eyes and ears in the home," he said.

The Western Eagle County community paramedic program will cost an estimated $1.5 million over five years, but Montera estimates it will save $9.9 million in health-care costs.

So far, the program has attracted $800,000 in support from interested parties.

A paramedic visiting the home can also assess other needs the patient may have and bring in other aiding organizations, Montera said, such as the American Red Cross, social services, substance-abuse treatment groups, or energy-assistance programs.

Further, paramedics can check homes for environmental hazards.

Montera pointed out that home health-care coverage often does not apply to patients older than 1 and younger than 65. The community paramedic program offers a chance to fill that gap.

Local EMS organization representatives attended the presentation. Southwest Memorial hopes to launch a similar program in the coming weeks.

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