Dr. Michael Wilcox October 2015 SIM-EPLC LEARNING TEAM DISCUSSION

THE ACCESS DILEMMA RURAL AND REMOTE 1/4 of Americans live in rural and remote areas 1/4 of Americans live in rural and remote areas Only 10% of America ’ s doctors practice there Only 10% of America ’ s doctors practice there 4 times as many rural and remote residents travel > 30 miles for health care compared to urban residents 4 times as many rural and remote residents travel > 30 miles for health care compared to urban residents

RURAL AND REMOTE DEMOGRAPHICS More elderly More elderly More immigrants More immigrants More poverty More poverty Poorer health Poorer health

Expand role, not scope Expand role, not scope Assess and identify gaps between community needs and services Assess and identify gaps between community needs and services Improve quality of life/health Improve quality of life/health THE COMMUNITY PARAMEDIC PROGRAM THE COMMUNITY PARAMEDIC PROGRAM

VOLUNTEER AND PAID PARAMEDICS EMTs/Paramedics already know how to deliver care locally EMTs/Paramedics already know how to deliver care locally Assess resources and make decisions Assess resources and make decisions They can fill gaps in care with enhanced skills through targeted training They can fill gaps in care with enhanced skills through targeted training

EXPANDED SERVICES Primary care Primary care Emergency care Emergency care Public health Public health Disease management Disease management Prevention Prevention Wellness Wellness Mental health Mental health

KEYS TO COMMUNITY PARAMEDIC PROGRAM GAP-FILLING FLEXIBL E RESOURCEFUL SERVING THE UNDERSERVE D

FLEXIBLE Identify specific needs in community health care Identify specific needs in community health care Standardized curriculum, modified for communities Standardized curriculum, modified for communities

ADDRESSING THE NEEDS OF THE UNDERSERVED Target populations with problems in access to health care Target populations with problems in access to health care Address special population issues Address special population issues Rising health disparities Rising health disparities Aging Aging Decreasing medical workforce Decreasing medical workforce

RESOURCEFUL Identifies what is available Identifies what is available And what is missing And what is missing

GAP-FILLING Creates “ health home ” for citizens Creates “ health home ” for citizens Eyes, ears, and voice of community Eyes, ears, and voice of community

COMMUNITY PARAMEDIC GUIDELINES Essential oversight by community care providers Essential oversight by community care providers Practice where designated underserved Practice where designated underserved Approved and welcomed Approved and welcomed Funding specific to locale Funding specific to locale

CARING FOR HIGH-RISK PATIENTS CARING FOR HIGH-RISK PATIENTS Patients taking 10 or more medications Patients taking 10 or more medications Patients who have tight therapeutic window medications such as “ warfarin ” Patients who have tight therapeutic window medications such as “ warfarin ” Patients who have 3 or more chronic diseases Patients who have 3 or more chronic diseases Patients with Mental health and disabling conditions Patients with Mental health and disabling conditions

HENNEPIN TECHNICAL COLLEGE - TRAINED BY LOCATION Florida Minnesota Maine Canada Nova Scotia Washington North Dakota Nevada Idaho Missouri Kansas New Jersey North Carolina Kentucky Saudi Arabia

COMMUNITY PARAMEDIC TRAINED OR IN TRAINING Spring Program 2008Metro & Outstate MN8 Fall Program 2010Rural5 Spring Program 2012Metro12 Fall Grant Class Fall Program Class 2013Metro & Out of State20 Spring Program 2013Metro, Outstate MN24 Spring Grant Class Spring Northern MN Fall Program 2013Metro, Outstate24 Fall Grant Class

THE COMMUNITY PARAMEDIC PROGRAM Level 1 -- Non-paramedic filling some roles of the Community Paramedic Level 1 -- Non-paramedic filling some roles of the Community Paramedic Level 2 – Certificate or Associate Degree Level 2 – Certificate or Associate Degree Level 3 -- Bachelor ’ s degree Level 3 -- Bachelor ’ s degree

CURRICULUM IS IN PLACE Standardized multi-module delivery model Standardized multi-module delivery model Applicable across America and internationally Applicable across America and internationally 14 credit certificate 14 credit certificate

CONTENT Chronic disease management Chronic disease management Cardiac, respiratory, diabetes, neurological Cardiac, respiratory, diabetes, neurological Pathophysiology Pathophysiology Pharmacology Pharmacology Mental health Mental health Text books Text books

CURRICULUM PHASE II Clinical 196 hours Clinical 196 hours

THE CLINICAL EXPERIENCE Primary care Primary care Community Health/Hospice Community Health/Hospice Wound care Wound care Behavioral Behavioral Cardiology & respiratory Cardiology & respiratory Pediatrics & geriatrics Pediatrics & geriatrics Networking Networking

Questions? Michael Wilcox M.D., FACEP, FAAFP