Impact of Paramedics Providing Care at Home program on equity of access to care: How does access to, and impact of, Paramedics Providing Palliative Care at Home vary across geographic, demographic and socio-economic sub-groups?

Across Canada the majority of people living with a chronic disease (e.g. cancer, heart failure) wish to spend to the end of life at home. The award-winning Paramedics Providing Palliative Care at Home Program was launched in 2015 in Nova Scotia allowing paramedics to give care at home, without taking the person to the emergency department. The program is now spreading across Canada. Patients/families report being very happy with the Program, and palliative care teams say it has been incredibly valuable as a 24/7 safety net to patients who want to stay home. We know from our earlier work in Nova Scotia that paramedic palliative support often helps keep the person at home. We want to make sure that this holds true in other settings as the program spreads. We also know that in general people use more health care support near the end of life, and people may call for paramedic palliative support more than once, particularly as end of life nears. We want to understand whether things like access to supports make this look different for different people. We do have some sense that there are differences, and we want to look at socio-economic data (e.g., average income or education in a community) and formal and family/caregiver supports available, to see if this changes whether people can stay home. While care at home is often what patients/families want, it shifts the support into the community, in ways we can't measure from hospital/paramedic charts. We will survey people to understand what social and health supports exist: Palliative Care Teams or other specialists, a family doctor, family or friends, socio-economic factors that change the ability to stay home. We want to make sure that everyone is getting the most from the Program, not just people who can access other supports because they live in a large city or have a high paying job and benefits, especially as the program grows. This project also sets the stage for more study as the Program expands.