Advanced paramedic practitioners
Health Technology Wales
Record ID 32018013714
English
Authors' objectives:
This report aims to identify and summarise evidence that addresses the following research question: What is the clinical and cost effectiveness of advanced paramedic practitioners, compared to paramedics with standard competencies?
Authors' results and conclusions:
HTW identified one pilot study report for advanced paramedic practitioners, specifically. Following expert consultation and due to this lack of evidence evaluating advanced paramedic practitioners as defined in the inclusion criteria, HTW’s Assessment Group decided evidence from other studies evaluating emergency care practitioners with enhanced skills should also be discussed to aid decision-making. HTW identified one piece of national guidance, one rapid review, one mixed methods review and a pilot report. The evidence included in the review suggests that emergency care practitioners with enhanced skills, including advanced paramedic practitioners, may be effective in reducing the number of patients conveyed to emergency departments and hospitals, being more likely to discharge patients at the scene.
One pilot study suggests that advanced paramedic practitioners may be effective in reducing the number of people conveyed to emergency departments. The impact of advanced paramedic practitioners on other outcomes remains unclear.
Studies of other interventions show better conveyance outcomes for professionals with enhanced skills, than those without. People treated by professionals with enhanced skills are also more satisfied with their care. There was limited evidence on the safety of care. No statistically significant differences in recontact rates, unplanned attendances, mortality, or quality of life have been shown. However, much of the evidence for these outcomes was deemed low quality.
No economic evidence was identified for advanced paramedic practitioners who attain postgraduate qualifications over two- or three-years’ training. One partially applicable economic study considered paramedics with enhanced skills, who had undergone less training. This UK cost-utility study showed that paramedics with enhanced skills reduced conveyance rates for older adults, mostly experiencing falls, without increasing overall health and social care costs. Quality of life was also similar for people seen by paramedics with enhanced skills or those with standard competencies. The evidence identified did not support new economic analysis. The cost effectiveness of advanced paramedic practitioners in Wales is therefore unclear.
Authors' recommendations:
The use of advanced paramedic practitioners in pre-hospital emergency care shows promise, but there is currently insufficient evidence to support routine adoption.
There is limited comparative evidence available against standard care and the wide range of roles and competencies of pre-hospital practitioners included in the published studies limits the certainty of this evidence. A full assessment of cost effectiveness is not possible on the basis of the currently available evidence.
Authors' methods:
The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.
Authors' identified further research:
HTW recommends further research, using system-orientated approaches to the analysis of data currently available in Wales, and incorporating patient and organisational outcomes into future comparative studies. Further research to address costs and cost effectiveness associated with the use of advanced paramedic practitioners in emergency care is also recommended.
Details
Project Status:
Completed
Year Published:
2024
URL for published report:
https://healthtechnology.wales/reports-guidance/advanced-paramedic-practitioners/
English language abstract:
An English language summary is available
Publication Type:
Rapid Review
Country:
Wales, United Kingdom
MeSH Terms
- Paramedics
- Emergency Medical Technicians
- Paramedicine
- Emergency Medicine
- Education
- Emergency Medical Services
Keywords
- Paramedicine
- Emergency care providers
- Emergency medicine
- Postgraduate education
- Advanced paramedic practitioners
Contact
Organisation Name:
Health Technology Wales
Contact Address:
c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD
Contact Name:
Susan Myles, PhD
Contact Email:
healthtechnology@wales.nhs.uk
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.