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Community Paramedicine at Clinic (CP@Clinic)

Older adults are more at risk of developing cardiovascular disease, diabetes and experiencing falls which can lead to 911 emergency calls resulting in expensive emergency room visits. Community-based health screening programs that link with a person’s primary care team and promote the health of older adults may reduce the need for 911 calls.

In the Community Paramedicine at Clinic (CP@clinic) research program, paramedics hold drop-in sessions at subsidized housing buildings. At these sessions, they conduct evidence-based health risk assessments using validated tools to assess building residents’ health risks. Decision-based algorithms guide paramedics in providing participants with tailored health education and referrals to primary care and community resources. Dr Gina Agarwal and the McMaster Community Paramedicine Research Team are actively researching its adaptations: contexts, population, and delivery systems.

Development of the Evidence Based CP@clinic Program:

In 2010, a team of highly experienced clinicians and researchers at McMaster University Department of Family Medicine, began to recognize the surge of 911 calls from subsidized housing buildings in Hamilton, Ontario. These escalated call volumes were confirmed by our partners – Paramedic Services, Public Health and City Housing.

CP@clinic began as a pilot study in the City of Hamilton with the McMaster University Department of Family Medicine, Hamilton Paramedic Services and City Housing Hamilton. From there it expanded to a randomized control trial (RCT) in Hamilton, Guelph-Wellington County, York Region, Greater Sudbury and County of Simcoe. Other CP@Clinic research expansion sites are listed below

Current Status:

In April 2019, Dr. Gina Agarwal was awarded Health Care Policy Contribution Program (HCPCP) funding by Health Canada to expand the innovative CP@clinic program with paramedic services across Canada. CP@clinic expansion is being guided by collaborating paramedic representatives on the CP@clinic Executive and Advisory Committees. These committees will assist with the scientific development and operational implementation of CP@clinic, including program materials, website, paramedic training and CP@clinic toolkit.

Visit the CP@clinic website for more details.

Principal Investigator

Partner Organizations

Paramedic Partners
  • Brant Brantford County
  • Chatham-Kent EMS
  • Cochrane District EMS
  • Essex-Windsor EMS
  • Guelph-Wellington Paramedic Services
  • Frontenac Paramedic Services
  • Grey County Paramedic Services
  • Halton Region Paramedic Services
  • Hamilton Paramedic Services
  • Hastings-Quinte Paramedic Services
  • Norfolk County EMS
  • Oxford County Paramedic Services
  • Peel Regional Paramedic Services
  • United Counties of Prescott and Russell Paramedic Services
  • Simcoe Paramedic Services
  • Greater Sudbury Paramedic Services
  • Weeneebayko Area Health Authority Paramedic Service
  • York Region Paramedic Services
Housing Partners:
  • Kingston & Frontenac Housing Corporation
  • City Housing Hamilton
  • Social Housing Haldimand & Norfolk
  • Greater Sudbury Housing Corporation
  • Cochrane District Social Services Administration Board
  • Grey County
  • The Corporation of the County of Wellington
  • Region of Peel
  • County of Simcoe
  • Housing York Inc.
National Organizations:
  • Ontario Association of Paramedic Chiefs
  • Paramedic Chiefs of Canada
Technology Partners:
  • Interdev Technologies
  • PreHos Inc.
Notable Publications

Agarwal G, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J, et al. Reducing 9-1-1 Emergency Medical Service Calls By Implementing A Community Paramedicine Program For Vulnerable Older Adults In Public Housing In Canada: A Multi-Site Cluster Randomized Controlled Trial. Prehosp Emerg Care 2019;23(5):718-729.

Agarwal G, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J, et al. Evaluation of a community paramedicine health promotion and lifestyle risk assessment program for older adults who live in social housing: a cluster randomized trial. CMAJ 2018;190(21):E638–E647.

Agarwal G, Brydges M. Effects of a community health promotion program on social factors in a vulnerable older adult population residing in social housing. BMC Geriatrics 2018; 18, 95 (2018).