Time to reshape our delivery of primary care to vulnerable older adults in social housing?

Administering influenza vaccinations

In recent years, traditional vaccination delivery has been moving beyond the GP’s office to community-based locales to boost administration of the annual flu vaccine through local initiatives. Vaccination task-shifting has included community-based flu clinics administered by nurses and outreach by paramedics to frequent callers of emergency health services. Growing these local initiatives into widespread standard practice and consolidating efforts via these delivery mechanisms could enable provision of influenza vaccine to a greater proportion of older adults in their homes or nearby, improving accessibility and coverage. This strategy could be expanded to pneumonia and shingles vaccinations, as well as COVID-19 vaccinations in the future.

Maintaining primary care connections with the movement to telehealth/virtual health

The pandemic has accelerated the transition to remote primary care provision using telehealth or virtual health. Although increasing accessibility to primary care for many, it leaves older adults on low incomes stranded because of limited internet access or technology user-challenges, and older adults’ perceptions of using technology for health care is mixed.¹¹ However, these are not insurmountable hurdles. Social housing working effectively with community organisations and volunteer groups can aid residents in using technology, facilitating connection with their GP. Many programmes exist in the UK and North America pairing the lay public or healthcare students with older adults by phone, mitigating loneliness.^12,13 Such programmes could expand to have volunteers facilitate connections between older adults and their GP. These efforts could be enhanced through government investment in internet services for social housing buildings or organisations donating tablets for use with residents. Older adults can be supported in keeping the critical connection with their GP while also encouraging broader social engagement through technology.

Ensuring monitoring of patients with chronic diseases

Although volunteers can facilitate a primary care connection, they cannot conduct medical assessments. Instead, task-shifting, utilising other healthcare professionals, is a potential strategy. In Canada, paramedic services implemented the Community Paramedicine at Clinic (CP{at}clinic) programme¹⁴ in social housing common rooms to decrease cardiometabolic risks and improve quality of life of residents. This programme reduced emergency medical calls from those buildings, benefiting the health system.¹⁴ Residents had their health concerns addressed by a community paramedic and socialised with other residents in this new venue. CP{at}clinic programme modifications now include over-the-phone health risk assessments and infection control measures. In-person assessments will only be utilised if needed. All health findings are faxed to the primary care providers so that the GP can contact their patients when an assessment result is flagged as abnormal, reducing unnecessary COVID-19 exposure. In the UK, modelling the CP{at}clinic programme’s methods, expansion of the traditional health team with paramedics is being piloted in an effort to increase the reach of primary care.¹⁵ The aim is to offer an alternative to people directly accessing GP services as the first point of contact for healthcare issues.

These additional supports should be co-delivered with GPs so that they are more aware of the preventable health issues their older adult patients in social housing face. Many in this marginalised, vulnerable population may have multiple health-related conditions that are not currently being effectively managed and who would benefit from improved disease management through communication and information sharing with GPs. Connecting social housing residents back to primary care benefits healthcare service delivery and promotes continuity of care.