A scoping study and qualitative assessment of care planning and case management in community paramedicine

Introduction:  Community paramedicine (CP) establishes an ongoing patient relationship beyond short emergency care episodes. How care planning and case management have been adapted from the isolated incidents of traditional practice is unclear.  The objective of this study is to contribute to paramedic practice by examining broad areas of care planning in CP, identifying gaps in the evidence, clarifying key concepts, and reporting on the types of evidence that address and inform practice.  A qualitative analysis of included literature outlines program capacities and identifies comprehensive models of care that can inform clinical practice in CP.   Methods:  A scoping study was completed that included conducting a systematic search of the literature (in MEDLINE and CINAHL) and selecting relevant studies, followed by data extraction, summarizing, and reporting.  The authors of included studies were contacted to confirm the aspects of care planning that were extracted from their respective studies.  Aspects of care planning were compared between studies and used to generate a comprehensive list of existing practices.   Results:   Ten of 1648 studies met inclusion criteria.  Qualitative analysis identified 22 aspects of care planning along four themes; enrollment (n=3), assessment and management (n=6), intervention and care (n=5), and collaboration (n=8).  No study included all 22 aspects of care planning.  One aspect of care planning was present in all 10 studies; collaboration with primary care providers.   Conclusion:  The aspects of care planning identified through this study provide a framework that can guide service providers in the delivery of care and researchers in defined outcome measures to be assessed.  Future program development should be guided by the finding that all articles included in this study included collaboration with primary care providers.  By summarizing care planning within CP programs, ongoing program development can embrace collaboration with other care providers to help insure that patients receive the appropriate care.