Paramedic services are developing a new model of service delivery known as community paramedicine (CP). This service delivery model seeks to build on existing paramedic skills, establish collaboration with non-traditional health care partners, and create alternative pathways for accessing care. Frequent users of paramedic services represent patients that are of particular interest to CP programs. Chapters 2 and 3 of this thesis address questions of effective delivery of these programs. The second chapter is a spatial-temporal analysis of frequent users in Hamilton, ON. Drawing on concepts of time-geography and dynamic ambulance deployment, this analysis identifies space-time patterns in paramedic service utilization by frequent users. Data were aggregated to represent daily demand in terms of space and time. Analysis employed generalized linear mixed models that included a random slope effect for time intervals for each geographic unit. Fixed effects included distance to emergency department, proportion of residential addresses, and proportion of older adult population. Locations and times that had greater or less than expected daily demand from frequent users were identified. The findings can be used to tailor deployment of community paramedics in dual-capacity roles to address the system demand of frequent users. The third chapter analyzes the geographic influence of CP service delivery in Renfrew County, ON. This research draws on concepts of spatial accessibility and geographic profiling to estimate spatially defined probabilities of paramedic service use by frequent users. Due to ongoing CP programs within the county, the resultant community health profiles serve as an evaluation of the benefit of these programs. The community health profiles can also be used to assess community level probabilities of patient needs for future interventions. This analysis can serve as a new way to assess spatial accessibility to health care services and identify locations with increased risk of frequent use of paramedic services.

Master of Arts (MA)

Thesis