Palliative paramedicine: An interrupted time series analysis of pre-hospital guideline efficacy
Abstract
Background: Paramedics are increasingly involved in palliative care and often support community-based palliative care service delivery to facilitate integrated practice. However, the impact of specific palliative care guidelines on clinical practice remains unknown. Aim: To determine the impact of an ambulance service palliative care guideline on rates of supportive medication administration and non-transport. Design: A retrospective cohort study of electronic patient care records from January 2014 to June 2023. Baseline characteristics were compared pre- and post-guideline introduction. Interrupted time series analysis was performed to examine guideline efficacy. Setting/participants: Patients of all ages receiving palliative care who were attended by paramedics in Victoria, Australia. Results: A total of 31,579 patients were included. The median age was 75 years (IQR = 64–84 years), and 56.4% were men. Overall, 25.8% of patients were not transported to hospital. Following guideline introduction, there were no significant trend changes in administration of supportive medications. However, the non-transport rate increased significantly per month (0.2%, p = 0.007), amounting to a 9.9% (p = 0.020) total increase by the end of the study period compared to a scenario in which the guideline had not been introduced. Subgroup analysis of patients diagnosed with ‘pain’ or attended after-hours also showed significant increases in non-transport (monthly increase: pain 0.3%, p = 0.003;…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 31,579 participants or records.
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