Service use of older people who participate in primary care health promotion
Health promotion for older people has potential to improve health and independence, and reduce service use. Successful initiatives require both an effective intervention and reaching the right population. Previous research has described the socio-demographic characteristics of participating patients, but not defined groups that could be targeted. Our aim was to identify and describe groups of older people who may take part in primary care health promotion based on their current service use.
We invited a random sample of 1 in 3 community-dwelling older people (≥65 years old) from five practices in London and Hertfordshire to participate a health risk assessment tool intervention aimed at promoting self-care and well-being (Multi-dimensional Risk Appraisal system for Older people) which was contextualised to each locality. Care home residents, those with severe incapacitating/terminal illness and those unable to provide informed consent were excluded. Postal questionnaires were sent to all eligible participants. Data collected included socio-demographic characteristics, well-being and functional ability, lifestyle factors and service use. Latent class analysis was used to identify participating groups of primary care health promotion. Groups were generated based on probabilities of use of the following services: secondary care, primary care, community healthcare, paid care, unpaid care, leisure, and local authority. The number of groups chosen for the latent class analysis was based on goodness of fit of the model and discussion within the research team. The socio-demographic characteristics of each group were described and statistically significant differences between groups assessed using univariate logistic regression, weighted for probability and clustered by GP practice.
The response rate was 34% (526/1550) with 447 participants returning completed questionnaires suitable for analysis. Latent class analysis using three groups gave the most meaningful interpretation and best model fit. Group A, “active well” (n=154), were low service users who were generally younger with better health and more physically active. Group B, “high NHS users” were the highest users of primary and secondary NHS care (n=121). Group C, “community service users” (n=172), used more local authority and leisure services, but fewer NHS services. Group C were older with more health problems and disability, less physically active, more educated, more likely to be lonely, and to live alone and had transport difficulties.
About a third of those agreeing to take part in primary care health promotion were fit and active with low service use. Just over a third had high impairments and used community health and other services without much hospital attendance. Just under a third, Group B, had high impairments with high hospital contact, and low social care input and this is potentially the group for whom interventions to reduce secondary care use might be most effective. Primary care-led health promotion initiatives have the potential to reach this group.