Dr. Michael Wilcox FACEP, FAAFP
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Transcript of Dr. Michael Wilcox FACEP, FAAFP
Community Paramedicine in Minnesota, 2014
EMS Medical Directors Annual ConferenceArrow Wood Lodge | Alexandria, MN9/5 – 9/7 2014
Dr. Michael Wilcox
FACEP, FAAFP
Introduction
The dilemma: access to health care is becoming more difficult (rural and Metro)
Complicated by increasing numbers of elderly, immigrants, the uninsured, and mentally challengedBetween 2010 and 2050, U.S. population will
increase by 42% (310 to 439 million) More diverse racially aggregate minority
population will be come the majority by 2042. By 2030, 20% will be >65 year of age.
Introduction
Further impacted by the Federal Accountable Health Care Act passed in 2013
Compounded by a lack of primary care providers (MD, NP, PA)
Minnesota’s Response
In an effort to address these issues, Minnesota in 2007, funded a pilot program to educate skilled paramedics to increase their role in providing primary care unto the needy members of their communities
A “Flex Grant” was provided by the Minnesota Department of Health, Office of Rural Health, to train 10 paramedics to this role.
Minnesota’s Response
I was the Medical Director of the program, and provided a summary of this initiative to this conference in 2009.
In 2010, Minnesota passed legislation to assist in paying these providers to do their work.
In 2012, the Minnesota Department of Employment/Economic Development, provided a $250,000 Jobs Skills Partnership grant to EMS organizations who wished to train a portion of their paramedics in pursing this career path
Minnesota’s Response
NMMC, Allina, Hennepin County and Health East participated in this initiative.
The Training Program
MnSCU, through Hennepin Technical College and later Inver Hills Community College, provided the academic curriculum.
The curriculum was developed by the North Central EMS Institute (Susan Long MA, BA, AS, NREMT-P, President)
It was heavily supported by Gary Wingrove NREMT-P, Mayo EMS and fine- tuned by many national and international instructors.
The Training Program
The program consists of 114 Didactic Hours and 196 clinical hours which lead to the attainment of 14 credits toward a degree.
Since its inception Hennepin Technical College has trained over 100 Minnesota Paramedics to this certification (over 300 national/international candidates).
Inver Hills Community College presently has 10 students in its program Kai Hjermstad NREMT-P – HTC coordinator Brad Wright NREMT-P – IHCC coordinator
HENNEPIN TECHNICAL COLLEGE - TRAINED BY LOCATION
Florida
Minnesota
Maine
Canada Nova Scotia
Washington
North Dakota
Nevada
Idaho
MissouriKansas
New Jersey
North Carolina
Kentucky
Saudi Arabia
The CP Programs
Scott County Health Care Collaborative This program came into existence in 2009 The first Minnesota program to use CPs
Its made up of a partnership including the Mdewakanton Sioux Community, Scott County Public Health, and the Faith Communities of Scott County
Provides medical care freely to the uninsured, under insured of Scott County
Medical Director: Michael R. Wilcox MD Coordinator: Merrilee Brown, RN; Scott County
Public Health Nurse Director
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
Mobile Clinic
SCOTT COUNTY MED-FIRE CLINICS
Med-Fire medical van travels to five areas throughout Scott County every two weeks
14-20 patients per sessionAccess issues – cannot
afford insuranceIdentify a medical home
The CP ProgramsNorth Memorial Medical Center
Program came into existence in 2012 At the present time they have 10 paramedics certified to the level of CP
It is a nationally recognized program to provide care to the needy of the northwest metro area
They have recently increased their FTEs to 3 CPs, seeing patients in their home 12 hours a day 7 days a week
Patient numbers: 12 – 16 per day These CPs see “High Medical Risk Recall Patients”
10 or more medications 3 or more chronic diseases Medications with a tight therapeutic window (Coumadin, Digitalis, etc) Mental health related comorbidities
Medical Director: Marc Conterato, MD Coordinators: Emilie Hedland, RN; Rick Wagner, NREMT-P
The CP ProgramsAllina EMS Transportation
Program came into existence in 2013Have 5 paramedics who have been certified to the
level of CPThese CPs are working with chronic disease patients
to reduce readmission into two of Allina’s HospitalsThese CPs are working also with mentally ill patients
to cut down on the need of transfer from busy emergency room settings
Medical Directors: Charlie Lick, MD; Paul Satterlee, MD
Coordinator: Corey Kissling BA, RN, NREMT-P
The CP ProgramsHennepin County EMS Transportation
Program came into existence in 2013 It has 1.5 FTE CPs who are serving patients in downtown
Minneapolis These CPs are working with patients referred from the
Emergency Room, Coordinated Care Center Clinic, Cardiology Clinic (CHF patients), and the Senior Care Clinic
15 – 20 patient encounters per FTE have been the norm CPs have found significant benefit in being able to spend an
extra 20 mins at the seen with their patients during 911 response to assist them in finding an ideal disposition for F/U
Medical Director: Brian Mahoney, MD Coordinator: Dave Johnson, NREMT-P
The CP Programs
Health East EMS Transportation This program came into existence in 2013 Has 4 working CPs dealing with issues of
behavioral health (medication compliance), follow up appointments, and home assessments In the future these CPs will deal with assessments
for chronic medical diseases, including diabetes, COPD, and cardiac issues.
Medical Directors: Peter Tanghe, MD; Keith Wesley, MD
Coordinator: Chris Schulz MHA, NREMT-P
The CP Programs
Tri-County Health Care EMS This program came into existence in 2013 Has 5 CPs providing 24/7 accessibility to health care They work in partnership with Wadena Public Health to
address gaps in health care determined by Wadena County Community Health Survey and TCHC’s health needs assessment
The partnership ensures local stakeholders are involved in providing a solution to the county’s health needs.
The initiative is tied to the hospital’s readmission program and the medical assistance readmission program.
The CP Programs The CPs do the following tasks during their home visits:
lab draws for long term care patients and home bound patients Trach-tube stoma care Bladder scans Medication administration to mentally ill patients Medication reconciliation Medication Education 12 Lead EKGs for long term care patients IV starts for long term care patients Wound care Home Safety assessments Post surgical visits (orthopedic care) Assist with transport of mentally ill and chemically dependent patients to
higher levels of care. Medical Director: John Pate, MN Coordinator: Allen Smith BS, NREMT-P
Summary
Over the next 50 years there will be an increased needs to access health care in Minnesota, the nation and the world
In an effort to address these needs the role of EMS within our communities will change
A greater focus on primary care provided by our EMS colleagues under the direction of a licensed MD/DO, NP, PA will be a major component of this initiative