Exploring the Integration of Paramedicine in Australian UCCs

In comparison to other high-income countries, Australia is facing a healthcare decline with access to primary care falling from 4th in 2017 to 8th in 2021 (1). The strong federal healthcare expenditure outlined in the 2023-24 budget of $385 million to open 58 Medicare Urgent Care Clinics (UCCs) and then expanded in the 2024-25 budget to comprise a total of 87, makes a start on repairing the inequalities and costs contributing to this decline, however existing legislation and policy, healthcare workforce challenges, siloed health services and fragmented funding models impede the ability for communities to receive the full benefit (2, 3).

The demand for urgent medical care is on the rise due to a range of factors such as population growth, aging demographics, and increasing healthcare needs. The latest ABS data reports 42.6% of patients in Australia wait more than 24 hours for care when it is urgent (4). Workforce availability is a contributing factor. The growth rate of General Practitioners (GPs) is less than 2% in metropolitan areas and much less in rural and remote regions. In comparison, Registered Paramedics (RPs) are the fastest growing healthcare workforce (5). RPs are traditionally associated with pre-hospital emergency care; however, they are emerging as potential contributors to urgent care service delivery beyond ambulance response. RPs possess complex knowledge and skills, and a broad scope of practice that enable them to work across a range of settings that includes primary care. Depending on location, paramedics may practice under medical direction or independently, often in unscheduled, unpredictable, or dynamic settings (6).

Paramedicine models of care are evolving from primary emergency care and transport roles, into providing emergency primary healthcare in place and refer to community options or transport to hospital if no suitable community options are identified (7). The introduction across Australia in 2022 of Medicare UCCs and other urgent care initiatives, that are open extended hours with imaging and pathology onsite, has provided an important alternative destination for conveyance to hospital- based emergency departments for minor injuries and illness (8). There are more than 23,000 RPs currently working across Australian communities (5). Expert opinion places around 80% of these working in a jurisdictional ambulance service, with the other 20% working in Aboriginal Community Controlled Health Organisations (ACCHOs), small private community health care services, industrial and mining workplace settings, and universities. It is reasonable in the next decade, with the current growth rate 700+ p.a. the projected population of RPs in Australia will be between 50,000 and 90,000. RPs are ideally placed to connect community appropriately with urgent care services as well as deliver high quality, urgent and emergent care in primary healthcare settings.

Learning Objectives
1) Study 1: Understand the analysis of the characteristics of patients conveyed to UCCs via ambulance
2) Study 2: Explore factors influencing Integration of Paramedics into multi-disciplinary UCC models

This presentation will involve a retrospective data analysis of patient care records following conveyance to an UCC (instead of an ED) by RPs working in a jurisdictional ambulance service over a 12-month period. The study will explore the patient condition, if this aligned to the services available at the UCC, what were the factors influencing the paramedic decision to utilise the UCC as a transport destination and any barriers to conveyance to urgent care, time from arrival to discharge. This research aims to provide evidence-based recommendations for the integration of paramedicine in UCC delivery in Australia.

It will also provide an update on progress on research into factors influencing Integration of Paramedics into multi-disciplinary UCC models. This qualitative exploration (Surveys and semi-structured interviews) will explore factors that influence the integration of RPs into multidisciplinary UCC teams. This research will explore novel employment of paramedics working in urgent care settings in Queensland. It will include surveys and semi-structured interviews with key experts.

THIS SESSION IS NOT ELIGIBLE FOR CME CREDIT