McFarlane, Shamiel (2018). Role of primary healthcare professionals in improving access to care and health outcomes of socially isolated older adults in Jamaica: a mixed methods study.McGill Family Medicine Studies Online, 13: e14

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Abstract 

Introduction: Social isolation has an overall negative effect on the physical health and well-being of older adults. While a qualitative study on Active Aging within the Caribbean and Latin America was performed in 2010, this study did not explore cohesiveness among the viewpoints of isolated older persons, community health aides and physicians, giving a voice to all parties involved in this healthcare ecosystem. In further examination of social isolation among older adults it is imperative to view the role of the health team on the aging population, seeing how the idiosyncrasies of the Caribbean filter into health and aging.

Methods: This study utilized a convergent multi-method approach. Quantitative methods(i)Self-administered paper survey of physicians to identify their current practices with patients and collect feedback on their perceived overall vulnerability of different patient populations, including isolated older persons over the age of 65.Qualitative methods: (ii)In-depth interviews with persons aged 65 and older to understand the challenges and social issues they face, (iii) a focus group with community health aides, and (iv) interviews with primary care physicians to identify organizational levers for promoting change in health workers' practices. The results of this study are presented here by integrating the results of the survey, the 5 in-depth interviews, 2 physician interviews and the focus group around main themes from a deductive framework, seeking convergence among the viewpoints of each party.

Results In total, 60 primary health care physicians responded to the survey (80% response rate), 5 socially isolated elderly persons completed in-depth patient interviews, one focus group was conducted with allied health workers, and 2 physicians participated in key informant interviews. Only a small percentage of survey respondents [n= 21/60, 35%] regarded older individuals as being among the more marginalized and vulnerable members of society. Socially isolated elderly persons interviewed would like their doctors to not only focus on physical health, but also "ask what's going on in my life." Most respondents agreed that it is the role of health workers to enquire about the underlying social challenges of their patients (n=43/60, 71.7%]. Physicians, however, were divided on whether it is their responsibility to address these social issues, with some believing that a simple referral to social work agencies is adequate while others advocate for broader intervention [Kruskal-Wallis 2= 16.775; df=2, p= 0.05, 2= 5.991]; [obs. diff 22.180233, critical diff 16.09816]. Notably physicians over age 50, those who spend more time with their patients and those who had previously delivered care to isolated patients, were more likely to consider it their responsibility to enquire about and propose solutions to the social issues of patients beyond referring to social work [p <0.001]. Physicians suggested a number of strategies that could be used at the clinical-level, the community level and the national level to better support socially isolated older adults.

Conclusion: Most health workers (physicians and community health aides) recognized the importance of addressing social isolation among older adults, yet were unaware of any outreach programs or mandates within their job description that would allow them to pursue this. A nationwide outreach program, supported by the medical council, was proposed by physicians who answered the survey as a promising approach to provide better access to services for isolated older patients. This program would also incentivize and train health workers on how to provide socially accountable care by linking this with accreditation processes, continuing professional development and medical license renewal. Better transportation and financial supports for patients were also identified as important structural levers to break social isolation and contribute to healthy aging.