Realist evaluation of the community paramedicine at clinic (CP@clinic) programme in rural Australian community health: protocol.

Abstract

The healthcare challenges associated with multimorbidity, population ageing and socioeconomic disadvantage are well known. This requires primary care services to adapt to greater population complexity and embrace new models of care. One example is the community paramedic (CP) role, which can provide screening, education and care coordination for complex and underserved populations. While relatively new in Australia, CPs have the potential to bridge primary care gaps especially in rural settings with workforce shortages. In this study, we are implementing an established and evidence-based Canadian CP programme (CP@clinic) in a new context: rural Australian community health services. The aim of our realist evaluation is to explore and explain how, why, for whom and in what circumstances CP@clinic works to improve health and social outcomes; benefit the paramedic workforce; bridge the gaps in primary healthcare and reduce emergency healthcare utilisation. Realist methodology is a theory-driven approach that explores how the causal mechanisms of an intervention are shaped by different contexts, leading to a variety of outcomes. We have developed an initial programme theory based on the Canadian experience and an earlier Australian pilot of CP@clinic. We will collect qualitative and quantitative data, including individual health and social outcomes, emergency services usage, healthcare costs, case reports, interviews with participants, paramedics and external stakeholders and process data. Analysis will follow a realist paradigm, using retroduction to compare findings to the original programme theory enabling us to confirm, refute and interrogate the proposed mechanisms. Ethical approval has been granted (McMaster University HiREB15194; La Trobe University HEC24495, 22038 and 22295). We have developed a multilevel dissemination plan to inform government, the paramedic profession, project stakeholders and consumers. The work is funded by the Australian government with annual reports provided. Other dissemination products will include journal articles, conference presentations, government presentations and submissions, an implementation guidebook and national webinar.