The protocol outlines a realist evaluation of the Canadian community paramedicine programme CP@clinic adapted for rural Australian community health services. The evaluation addresses known healthcare challenges associated with multimorbidity, population ageing and socioeconomic disadvantage, which increase complexity for primary care. Rural areas with workforce shortages are identified as settings where community paramedics could help bridge primary care gaps by providing screening, education and care coordination for complex and underserved populations.
The primary aim is to explore and explain how, why, for whom and in what circumstances CP@clinic works to improve health and social outcomes, support the paramedic workforce, close gaps in primary healthcare access, and reduce emergency healthcare utilisation.
CP@clinic is an established, evidence-based Canadian community paramedicine programme focused on preventive screening, health education and care coordination delivered by community paramedics. In this study, the existing CP@clinic model will be implemented in rural Australian community health services. The intervention retains core elements from the Canadian model and a prior Australian pilot, with the objective of evaluating its effectiveness and mechanisms in a new context.
Community paramedics in this programme are intended to provide services beyond traditional emergency response roles, including routine screening for health risks, targeted education to support self-management, and coordination with other primary care providers and services to address social and health needs.
The evaluation adopts a realist methodology, a theory-driven approach that examines how the causal mechanisms of an intervention are shaped by contextual factors to produce a range of outcomes. Realist evaluation focuses on context–mechanism–outcome configurations to explain why interventions work, for whom, and under what conditions.
An initial programme theory has been developed drawing on the Canadian CP@clinic evidence and insights from an earlier Australian pilot. This initial theory sets out proposed mechanisms by which CP@clinic might achieve intended outcomes in rural Australian settings and identifies contextual factors likely to influence those mechanisms. The realist approach will test and refine this theory through empirical data collection and analysis.
The study will collect a mix of quantitative and qualitative data to capture individual-level outcomes, service use and implementation processes. Reported data items and sources include:
These data streams will provide the evidence base to assess whether observed outcomes align with the initial programme theory and to elucidate context-dependent mechanisms.
Analysis will follow a realist paradigm using retroduction as a core analytic strategy. Retroduction involves iteratively comparing empirical findings with the initial programme theory to identify underlying mechanisms and the contextual conditions that enable or inhibit those mechanisms. Through this process the evaluation will aim to confirm, refute or interrogate proposed causal explanations and to refine the programme theory to better reflect how CP@clinic operates in rural Australian community health settings.
The realist analysis will synthesise quantitative outcome data with qualitative insights from interviews and case reports to develop context–mechanism–outcome configurations. These configurations will explicate how CP@clinic produces intended or unintended outcomes across different participant groups and service environments.
Ethical approval for the study has been obtained (McMaster University HiREB15194; La Trobe University HEC24495, 22038 and 22295). The project is funded by the Australian government, with annual reports provided to the funder.
A multilevel dissemination plan has been developed to ensure findings reach policy-makers, the paramedic profession, project stakeholders and consumers. Planned dissemination products and activities reported in the protocol include annual reports for the funder, journal articles, conference presentations, government presentations and submissions, an implementation guidebook and a national webinar. These activities aim to inform implementation practice, sector stakeholders and possible scale-up decisions.
Limitations and further details
The protocol summarizes methods and planned analyses; specific measurement instruments, sample sizes, timelines and site-level operational details were not reported in the source text. The realist evaluation framework and mixed-data approach are intended to produce transferable explanations about how CP@clinic may function in rural Australian contexts and to guide future implementation and policy decisions based on the refined programme theory.