Access to primary care for socio-economically disadvantaged older people in rural areas: A qualitative study

Ford, John; Turley, Rachel; Porter, Tom; Shakespeare, Tom; Wong, Geoff; Jones, Andy; Steel, Nick

doi:10.1371/journal.pone.0193952

Cited by 35 publications

(53 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Participants in our study perceived that older adults are 'set in their ways' or have low self-efficacy, and do not accept supports. Ford and colleagues report that health professionals perceive that the inconsistent use of primary care services by older adults is due the gap between their expectations and the adequacy of service provision [27]. Others argue that preferences, goals, and motivational priorities may change in aging, related to adaptation to losses as well as psychological development wherein new viewpoints and roles develop [28].…”

Section: Discussionmentioning

confidence: 99%

Disconnected relationships between primary care and community-based health and social services and system navigation for older adults: a qualitative descriptive study

et al. 2020

View full text Add to dashboard Cite

Background: There are gaps in knowledge and understanding about the relationships between primary care and community-based health and social services in the context of healthy aging at home and system navigation. This study examined provider perspectives on: a) older adults' health and social needs; b) barriers to accessing services; c) the nature of relationships between primary care and health and social services; and d) ways to facilitate primary care and health and social services navigation to optimize older adults' health. Methods: Four focus groups were conducted involving providers (n = 21) in: urban primary care clinics and health and social services organizations serving older adults in Hamilton, Ontario, Canada. Purposive sampling was employed to recruit community health and social services managers, directors or supervisors and primary health care providers in a Family Health Team via email. Results: Health and social services needs were exacerbated for community-dwelling older adults with multiple chronic conditions. Strong family/caregiver social support and advocacy was often lacking. Access barriers for older adults included: financial challenges; lack of accessible transportation; wait times and eligibility criteria; and lack of programs to address older adults' needs. Having multiple providers meant that assessments among providers and older adults resulted in contradictory care pathways. Primary care and health and social services linkages were deficient and complicated by poor communication with patients and health literacy barriers. Primary care had stronger links with other health services than with community-based health and social services; primary care providers were frustrated by the complex nature of health and social services navigation; and care coordination was problematic. Health and social services referred older adults to primary care for medical needs and gathered patient information to gauge program eligibility, but not without challenges.

show abstract

Section: Discussionmentioning

confidence: 99%

Disconnected relationships between primary care and community-based health and social services and system navigation for older adults: a qualitative descriptive study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…A recent report on CWL for attachment to a GP in Quebec found in 8.5% of cases where patients were not attached to the GP to whom they had been assigned, it was because they had missed their appointment [ 32 ]. Several studies have found that, in certain populations, patients with lower levels of social support were more likely to miss appointments [ 72 – 74 ]. Also, patients from more socially advantaged areas, by having someone such as a spouse to help explain their health status and advocate for their needs to the CWL nurse, may be more likely to be attached to a GP.…”

Section: Discussionmentioning

confidence: 99%

Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada

Smithman

Brousselle

Touati

et al. 2018

Int J Equity Health

View full text Add to dashboard Cite

BackgroundAccess to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada, socio-economically disadvantaged patients are more likely to be unattached (i.e. not have a regular GP). In the province of Quebec, where over 30% of the population is unattached, centralized waiting lists were implemented to help patients find a GP. Our objectives were to examine the association between social and material deprivation and 1) likelihood of attachment, and 2) wait time for attachment to a GP through centralized waiting lists.MethodsA cross-sectional study was conducted in five local health networks in Quebec, Canada, using clinical administrative data of patients attached to a GP between June 2013 and May 2015 (n = 24, 958 patients) and patients remaining on the waiting list as of May 2015 (n = 49, 901), using clinical administrative data. Social and material area deprivation indexes were used as proxies for patients’ socio-economic status. Multiple regressions were carried out to assess the association between deprivation indexes and 1) likelihood of attachment to a GP and 2) wait time for attachment. Analyses controlled for sex, age, local health network and variables related to health needs.ResultsPatients from materially medium, disadvantaged and very disadvantaged areas were underrepresented on the centralized waiting lists, while patients from socially disadvantaged and very disadvantaged areas were overrepresented. Patients from very materially advantaged and advantaged areas were less likely to be attached to a GP than patients from very disadvantaged areas. With the exception of patients from socially disadvantaged areas, all other categories of social deprivation were more likely to be attached to a GP compared to patients from very disadvantaged areas. We found a pro-rich gradient in wait time for attachment to a GP, with patients from more materially advantaged areas waiting less than those from disadvantaged areas.ConclusionOur findings suggest that there are socio-economic inequities in attachment to a GP through centralized waiting lists. Policy makers should take these findings into consideration to adjust centralized waiting list processes to avoid further exacerbation of health inequities.

show abstract

“…This may be because older people can have vague/irregular symptoms in combination with aging, meaning that there are unavoidable symptoms accompanied by prejudices [24,26,27,28]. However, there has been no study on the relationship between HSB and health outcomes, as well as aging [29,30]. Future research should investigate this relationship and interventions for improving older people's HSB should be developed.…”

Section: Discussionmentioning

confidence: 99%

What resources do elderly people choose for managing their symptoms? Clarification of rural older people’s choices of help-seeking behaviors in Japan

Ohta¹,

Ryu²,

Kitayuguchi³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Appropriate help-seeking behavior (HSB) that involves lay and professional care may moderate the usage of medical resources and promote good health, especially among the rural elderly. However, there is little evidence regarding the rural elderly’s HSB choices for mild symptoms. Therefore, this study attempts to bridge this gap. Methods The participants were patients living in rural areas and over the age of 65, who attended Japanese clinics and general hospitals. In Phase 1, monthly diaries and one-on-one interviews about their mild symptoms and HSB were used to establish checklist items and assess content validity. Content analysis helped determine the items. In Phase 2, participants were asked to complete the checklist to measure HSB. The checklist answers and HSB mentioned in the diaries were compared to evaluate construct validity. Retests were conducted to examine the content’s reliability and test-retest reliability. Results Phase 1 included 267 participants (average age = 75.1 years, standard deviation [SD] = 4.3; 50.1% male). The diary collection rate was 97.6%. Of the participants, 70.4% used lay care and 25.4% used professional care. Content analysis identified eight types of lay care and four types of professional care. Phase 2 included 315 participants (average age = 77.7 years, SD = 8.27; 46.0% male). In terms of validity, the results of the checklists and the diaries were correlated (Spearman p 0.704; p < 0.001). The most common behavior with mild symptoms was consulting with primary care physicians, followed by self-care and using home medicine. The test-retest reliability for mild symptoms found kappa values of 0.836 for lay care and 0.808 for professional care. Conclusions The list of rural older people’s choices of HSB for mild symptoms had high validity and reliability. Therefore, it can be used to assess the relationships between HSB and health conditions and the effectiveness of health promotion on HSB among rural elderly people.

show abstract

Access to primary care for socio-economically disadvantaged older people in rural areas: A qualitative study

Cited by 35 publications

References 25 publications

Disconnected relationships between primary care and community-based health and social services and system navigation for older adults: a qualitative descriptive study

Disconnected relationships between primary care and community-based health and social services and system navigation for older adults: a qualitative descriptive study

Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada

What resources do elderly people choose for managing their symptoms? Clarification of rural older people’s choices of help-seeking behaviors in Japan

Contact Info

Product

Resources

About