Improving access to high quality primary care for vulnerable older people in rural areas Improving access to high quality primary care for vulnerable older people in rural areas

Summary

Vulnerable older people in rural communities often find it hard to get the help they need (e.g. many have difficulty travelling to their GP practice). This research will look at the problems preventing this group getting high-quality medical help, and will develop ways of overcoming these difficulties.

It will begin by reviewing previous research, followed by analysing a twelve year study of 17,000 older people. GPs, patients and healthcare planners will then be consulted. Solutions to make it easier for people to get medical help will be developed and tested in a small-scale study; pointing the way to a bigger study.

Interested in taking part

Information for members of the public

Information for health professionals

About the study

Interested in taking part?   

We are currently looking for members of the public and health professionals to take part in interviews and focus groups.

We would like to speak to any members of the public who answer “Yes” to the following questions.

  • Are you over 65 years old and live in a rural area?

  • Do you receive Pension Tax credit or Housing Benefit or Council Tax Support?

  • Does your health stop you from doing the things you want?

  • Do you have problems getting to and seeing your GP?

We are looking for the following health professionals to take part in focus groups:

  • GPs

  • Community matrons/case managers

  • Community geriatricians

  • Commissioners

  • District nurses

Information for members of the public

Study Summary

At the University of East Anglia we are looking at how people over 65 years old get to and use their GP. We know that some people find it difficult to see their GP. This study aims to identify the common problems and develop solutions.

What’s involved?

The study has several parts. Firstly a review of previous research, secondly asking people about their experiences, thirdly analysing a national information (a dataset) and finally designing a new service to help overcome these problems.

You’ve been invited to take part in the second part of the research (speaking to people).

We are looking for people who are

  • Live in rural areas and are over 65 years old,

  • Have a health problem which stops them doing the things they want, and

  • Receive pension tax credit, housing benefit or council tax support

  • And have good or bad experiences of getting to and using their GP

What would taking part involve?

Taking part will involve a discussion with a researcher from the University of East Anglia for about 2 hours. This will either be at the University or at home, whichever is easiest for you.

When we meet the researcher will tell you more about the research again and, if you’re happy to continue, will ask you to sign a consent form.

Then the researcher will ask you about your experiences of getting to talk to your GP. They will also ask you some focused questions. The discussion will be recorded on a Dictaphone so that which means we don’t need to take detailed notes at the time.

You are free to stop at any point in the discussion, without giving a reason.

What are the possible benefits of taking part?

Taking part will give you an opportunity to tell your story [and contribute to important research which we hope will help older people to get in contact with their GP more easily in the future.

If you have to travel to talk to the researcher, they will tell you how they will arrange to repay you.

Would taking part in this research cause me any problems?

Anything you say will be anonymised and none of the information will be passed on to your GP or anyone in the NHS.

Sometimes in this type of research issues are discussed which you may feel sensitive about. You do not have to answer any question you do not want to and can stop the discussion at any point, without giving a reason.

What will happen the information I provide?

Your information will be combined with everyone else’s and results analysed. This information will be deleted after 5 years.

We will ask you for basic contact information, in case we need to get in touch. This will be stored on the secure University computer system. This information will be destroyed after 5 years.

We will share the results at conferences and journal articles. Results will also be included the researchers PhD thesis. No one will be able to identify you from any of the results.

What will happen to the results?

The results will be used to design a new service which will be tested. The results are likely to also be report in a journal article and conference publication. No one taking part in the research will be identifiable from the results. You are very welcome to see a copy of the final research report summary please let John Ford know (details below).

Who is funding this research?

The National Institute for Health Research is providing funding for the whole study.

Who has checked that this study meets national research standards?

To obtain funding the study underwent a rigorous review process by the National Institute for Health Research. The University of East Anglia Faculty of Medicine and Health Sciences Research Ethics Committee has also reviewed this research.

Further Information

Please don’t hesitate to contact John Ford, the lead researcher.

John Ford
Research Fellow
Tel: 01603 591743
Email: john.ford@uea.ac.uk

Information for Health Professionals 

What’s involved?

The study has several parts. Firstly a review of previous research, secondly speaking to patients and health professionals, thirdly analysing a national dataset and finally designing a new service to help the problems.

You’ve been invited to take part in the second part of the research (speaking to health professionals).

We are looking for health professionals who fit into one of the following categories: GPs, community matrons/case managers, community geriatricians, commissioners and district nurses.

What would taking part involve?

Taking part would involve attending a focus group for 2-3 hours at the University of East Anglia. When we meet the researcher will talk through the study again and if you’re happy will ask you to sign a consent form.

The following discussion will be an opportunity for you to share your experience. Later in the discussion there is likely to be some focused questions. The discussion will be recorded which means we don’t need to take detailed notes at the time.

You are free to stop at any point during the focus group, without giving a reason.

What are the possible benefits of taking part?

Taking part will give you an opportunity to contribute to important research which we hope will shape future services.

You will be reimbursed for the cost of travel and time to take part in the focus group.

What are the possible disadvantages and risks of taking part?

Taking part in this type of research is very low risk. Anything you say will be anonymised and none of the information will be passed on to your GP or anyone in the NHS.

Sometimes in this type of research issues are discussed which are sensitive. You do not have to answer any question you do not want to and can stop the discussion at any point, without giving a reason.

What will happen with the information I provide?

Your information will be combined with everyone else’s and results analysed. This information will be deleted after 5 years.

We will ask for basic contact information, in case we need to get in touch. This will be stored on the secure University computer system. This information will be destroyed after 5 years.

We will share the results at conferences and journal articles. Results will also be included the researchers PhD thesis. No one will be able to identify you from any of the results.

What will happen to the results?

The results will be used to design a new service which will be tested. The results are likely to also be report in a journal article and conference publication. No one taking part in the research will be identifiable from the results. You are very welcome to see a copy of the final research report summary, if you wish to see a copy please let John Ford know (details below). 

Who is funding this research?

The National Institute for Health Research is providing funding for the whole study.

Who has reviewed this study?

To obtain funding the study underwent a rigorous review process by the National Institute for Health Research. The University of East Anglia Faculty of Medicine and Health Sciences Research Ethics Committee has also reviewed this research.

Further Information

Alternatively please don’t hesitate to contact the lead researcher.

John Ford
Research Fellow
Tel: 01603 591743
Email: john.ford@uea.ac.uk

About the Study 

Why is this research important?

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.

A review access to healthcare in the UK found that rural individuals, older people and those in poverty have reduced access to healthcare. Access to healthcare is likely to be even worse when more than one of these occur. Poor access leads to inequalities and increased use of services such as A+E, ambulances and out of hours GPs.

Who is funding the study?

This research is being funded by a National Institute of Health Research grant.

What is the aim?  

The aim of this study is to develop an intervention to improve access to high-quality primary care in vulnerable older people in rural areas and undertake a feasibility study of the intervention.

What methods are being used? 

The study has several parts. Firstly a review of previous research, by undertaking a realist review. This method is particularly interested in understanding questions such as “how?”, “why?”, “for whom?”, “in what circumstances?” and “to what extent?”.

Secondly semi-structured interviews and focus groups will be undertaken with members of the public and health professionals.

Thirdly, the English Longitudinal Study of Aging, a national cohort study with over 17,000, will be analysed to look at how older people access their GP. Geographical Information Software will be used to calculate distances, GP Access Survey will be used to assess access and Hospital Episode Statistics will be used to measure hospital use. Structural equation modelling will be used to bring all this data into one analysis.

These three components will be combined into one overall theory. An intervention will then be designed to overcome some of these barriers. This new intervention will be tested in a feasibility study. The feasibility study will give us the information needed to conduct a full trial.

Where is the research taking place? 

The University of East Anglia is hosting the research. Members of the public and health professionals will be recruited from Norfolk for the study.

Who are the research team? 

The research is being led by Dr John Ford as part of a PhD. Other people supporting the research at UEA include Dr Nick Steel, Prof Andy Jones, Dr Tom Shakespeare  and Prof Ann Marie Swart.

Dr Geoff Wong from the Blizard Institute is also supporting the research.

What are the timescales?

The first two years (November 2014 to October 2016) will be spent undertaking the literature review, interviews/focus groups and cohort analysis.

The second two years (November 2016 to October 2018) will be spent undertaking the feasibility study.

Who should I contact if I would like more information? 

If you would like to know more about the research, please contact Dr John Ford.