Access to Primary Care for Socio-Economically Disadvantaged Older People in Rural Areas: A Qualitative Study (Ford, 2018)
Ford, John A., Rachel Turley, Tom Porter et al., “Access to Primary Care for Socio-Economically Disadvantaged Older People in Rural Areas: A Qualitative Study,” PLOS One 13 no.3 (March 2018), doi:10.1371/journal.pone.0193952
URL: journals.plos.org/plosone/article?id=10.1371/journal.pone.0193952
Abstract
Objective: We aim to explore the barriers to accessing primary care for socio-economically disadvantaged older people in rural areas.
Methods: Using a community recruitment strategy, fifteen people over 65 years, living in a rural area, and receiving financial support were recruited for semi-structured interviews. Four focus groups were held with rural health professionals. Interviews and focus groups were audio-recorded and transcribed. Thematic analysis was used to identify barriers to primary care access.
Findings: Older people’s experience can be understood within the context of a patient perceived set of unwritten rules or social contract–an individual is careful not to bother the doctor in return for additional goodwill when they become unwell. However, most found it difficult to access primary care due to engaged telephone lines, availability of appointments, interactions with receptionists; breaching their perceived social contract. This left some feeling unwelcome, worthless or marginalised, especially those with high expectations of the social contract or limited resources, skills and/or desire to adapt to service changes. Health professionals’ described how rising demands and expectations coupled with service constraints had necessitated service development, such as fewer home visits, more telephone consultations, triaging calls and modifying the appointment system.
Conclusion: Multiple barriers to accessing primary care exist for this group. As primary care is re-organised to reduce costs, commissioners and practitioners must not lose sight of the perceived social contract and models of care that form the basis of how many older people interact with the service.
This focus group study of people over 65, who live in rural areas in the UK, provides unique insight into the perceived healthcare needs of older people, as well as the perceived challenges healthcare providers face in meeting those needs. While many of the barriers older people face related to social contract, healthcare providers significantly noted the double challenge of the medicalization of aging, which often limits their ability to provide help to older patients who truly need their attention, as well as the difficulties embedded within the current state of healthcare, which tends to marginalize disadvantaged older men and women in favor of the “worried well.”