Exploring Community Paramedicine for Chronic Disease Control and Stroke Prevention in Rural Georgia

Posted on June 18, 2024 by Brandon Calvert

This entry is part 4 of 7 in the series CVD Prevention 1

This post explores the effectiveness of Community Paramedicine in addressing stroke prevention and chronic disease management in rural Georgia, highlighting the urgency for intervention in the face of persistent health disparities.

Read the Article in JPHMP

In Georgia, stroke remains a significant public health challenge, particularly in rural areas, where communities face socioeconomic disparities. A 2019 study by the Georgia Coverdell Acute Stroke Registry (GCASR) underscored the urgency for intervention, as stroke mortality rates continue to exceed the national average. Notably, Georgians exhibited high prevalence rates of stroke-related risk factors, including smoking, uncontrolled hypertension, diabetes, and high cholesterol. Individuals who have previously had a stroke experience these risk factors at a higher rate. Stroke patients in Georgia face an increased risk of mental health issues, complicating their treatment and potentially leading to poor adherence and elevated suicide risk post-stroke.

While state and local health departments have started various initiatives to address this issue, the persistence of stroke and chronic disease necessitates innovative approaches. Mobile Integrated Health models, such as Community Paramedicine (CP), have emerged as viable solutions to leverage existing healthcare infrastructure to deliver services to rural communities that face barriers to healthcare access. These programs have led to improved health outcomes and financial stability for communities, translating into cost-saving opportunities and enhanced healthcare system performance and quality.

With support from GCASR and funding from the Centers for Disease Control and Prevention’s DP18-1817 program, our study assessed the effectiveness of the Community Paramedicine model. In our Journal of Public Health Management and Practice article titled, “Stroke Prevention and Management in Rural Georgia: Assessing the Impact of a Community Paramedicine Program,” we detailed our collaboration with two county EMS agencies and affiliated stroke treatment hospitals. We provided operational support, analysis, and access to social service programs and remote treatment and management tools to evaluate the program’s effectiveness in preventing stroke recurrence by managing chronic conditions among high-risk stroke patients.

Further reading, resources, and guidance for readers interested in learning more about Mobile Integrated Health and Community Paramedicine are available from the Rural Health Information Hub—https://www.ruralhealthinfo.org/topics/community-paramedicine

Key Findings

We enrolled stroke patients with a median age of 69, with a majority being male (52%) and non-Hispanic white (66%).
Participants exhibited high prevalence rates of hypertension (94%), hyperlipidemia (85%), and diabetes (55%), highlighting the importance of managing these conditions for stroke prevention.
Participants reported utilizing telehealth services in 28% of cases, indicating a potential avenue for mental health support and remote care.
Participants exhibited a significant increase in the odds of readmission for recurrent stroke within 90 days compared with non-participating stroke patients.
Participation in the program showed reduced odds of death resulting from recurrent stroke, although this trend did not reach statistical significance.
Although participation in the Community Paramedicine program was associated with reduced rates of all-cause readmission and mortality compared with stroke-related outcomes, these reductions were not statistically significant.

Inaction on chronic disease control in rural communities could exacerbate existing health disparities, leading to persistent or heightened morbidity and mortality rates. The Community Paramedicine model shows promise in addressing chronic disease management and stroke prevention in rural Georgia. While our findings suggest potential benefits, it is essential to recognize that our implementation targeting specific health conditions such as stroke is still in its pilot stages, as outlined in “Stroke Prevention and Management in Rural Georgia: Evaluating the Effectiveness of a Community Paramedicine Program.” We acknowledge that our study’s sample size and duration limit the certainty of these outcomes. However, as we continue to gather data and engage more participants, we hope to further continue the discussion of the model’s effectiveness in mitigating healthcare disparities in rural areas.

About the Author

Brandon Calvert: Brandon Calvert, MS, is a Healthcare Program Consultant at the Georgia Department of Public Health, specializing in project management and advisory services for chronic disease prevention initiatives. He holds an MS in Health Education & Promotion with a specialization in Health Policy & Advocacy.