Improving access to primary care for deprived older people living in rural areas: a mixed method study

N.B This abstract outlines ongoing work. Early findings from the realist review, cohort analysis and qualitative work will be presented.

The problem

Nine million people live in rural areas of England, of whom one in five is over 65 years old. In rural areas, the population of over 85 year olds is the fastest growing age group. Poverty is high in older rural people with a sixth of rural pensioners living below the poverty threshold (below 60% of median income). Access to primary care for rural older people is challenging with one in five living more than 4km from their GP practice and one in three not having access to a car. Poor access leads to preventable health inequalities, and increased use of urgent care services.

The approach

The aim of this study is to develop an intervention to improve access to high-quality primary care in socioeconomically disadvantaged older people in rural areas.An innovative mixed method design following the MRC developing complex interventions guidance is being used.The following methods will be used to develop theory: a) a realist review, b) an analysis of the English Longitudinal Study of Ageing (ELSA) and c) focus groups and semi-structured interviews with patients, clinicians and commissioners. The realist review identifies, from published and grey literature what works, for whom and in what context. Theory generated from the realist review will be tested in the ELSA analysis using structural equation modelling. Semi-structured interviews and focus groups will be used to explore underlying mechanisms and will include vignettes to test theory.A triangulation protocol ensures that each of these components can inform each other in an iterative manner. Using three different, but complimentary, methods to look at the same problem will ensure a fuller understanding of the issue. Data will be synthesised to one overall theory using a realist perspective.

Findings

Based on results an intervention will be developed. Dialogues with clinicians, commissioners and patient groups will be used to iteratively refine the intervention and ensure it is feasible and practical for the NHS.Consequence This study uses a novel mixed method design to integrate multiple sources of evidence in order to develop a complex intervention.The research has the potential to improve access to primary care for some of the most vulnerable people in society. Through improving access and engagement with primary care, it is expected that patients will contact primary care at an earlier stage to facilitate early management. This will improve patient health, narrow health inequalities and reduce use of urgent care services.

Credits

• John Ford, Queen Mary's University, London, UK
• Andy Jones, Queen Mary's University, London, UK
• Geoff Wong
• Tom Shakespeare, Queen Mary's University, London, UK
• Tom Porter, Queen Mary's University, London, UK
• Nick Steel, Queen Mary's University, London, UK