Effects of the Community Paramedicine at Clinic (CP@clinic) program on the health behaviours of older adults residing in social housing: secondary outcomes of a cluster-randomized trial
Bibliographic record
Abstract
BACKGROUND: Community-dwelling, low-income older adults who reside in social housing are a vulnerable population with high rates of poor health behaviours that contribute to chronic health conditions and adverse health outcomes. This study investigates the impact of the Community Paramedicine at Clinic (CP@clinic), a chronic disease prevention, management, and health promotion program, on the health behaviours of this population. METHODS: An open-label, pragmatic cluster-randomized controlled trial with parallel intervention and control groups was conducted for one-year within 30 social housing buildings in Ontario, Canada. Eligible buildings were required to have a postal code not shared with other addresses, a majority of tenants aged 55 years or older, at least 50 units, and a similar building available for matching. Buildings were paired and randomized to either intervention (CP@clinic program) or control (usual care) groups. The CP@clinic program was conducted in the common spaces of the intervention buildings and consisted of weekly drop-in sessions facilitated by trained community paramedics. Older adults met one-on-one with community paramedics who conducted evidence-based risk assessments, made referrals to community and healthcare resources, provided health education, and reported health assessment results back to family physicians. Pre- and post-intervention surveys were conducted. Descriptive statistics were used to describe demographic characteristics and health behaviours. Mann-Whitney U tests were conducted to compare individual-level change in health behaviours between intervention and control groups. RESULTS: From the 15 intervention and 15 control buildings, 656 participants completed either the pre- and/or post-intervention survey; the mean age was 72.1 (SD 8.7) years, 75.6% were female, 91.6% were not married, 89% were white, 68.4% obtained a high school education or less, and 90% lived alone. After the intervention, the individual-level consumption of weekly fruit and vegetables and time spent watching TV improved significantly (p < 0.05) for the intervention group compared to the control group (z-scores = -2.467 and -2.194, respectively). The change in consumption of carbohydrate/grains increased significantly for the intervention group compared to the control group (z-score -2.023, p < 0.05). CONCLUSION: The CP@clinic program is an innovative wellness program that had a significant impact in changing health behaviours, especially in weekly fruit and vegetable consumption, among a vulnerable older adult population. TRIAL REGISTRATION: ClinicalTrials.gov NCT02152891, registered June 6, 2014.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.006 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".