Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Medical Education Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Ann Fam Med. 2018 Sep;16(5):393-398. doi: 10.1370/afm.2257.
Social isolation has been identified as a major health problem, particularly in the elderly. In the present study, we examine the association between social isolation and patient experience in elderly primary care patients.
This cross-sectional study was conducted in a primary care practice-based research network (28 clinics) in Japan. We assessed social isolation using an abbreviated Lubben Social Network Scale and patient experience of primary care using a Japanese version of the Primary Care Assessment Tool (JPCAT), which comprises 6 domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. We used a linear mixed effects model to adjust clustering within clinics and individual covariates.
Data were analyzed for 465 elderly primary care patients aged ≥65 years. After adjustment for possible confounders and clustering within clinics, social isolation was negatively associated with the JPCAT total score, (mean difference = -3.67; 95% CI, -7.00 to -0.38). Among the JPCAT domain scores, social isolation was significantly associated with longitudinality, comprehensiveness (service provided), and community orientation scores.
Social isolation was associated with negative patient experience in elderly primary care patients. Raising awareness regarding patient social networks among primary care providers and targeted interventions for socially isolated elderly patients aimed at improving the experience of primary care, especially regarding longitudinality, comprehensiveness, and community orientation, may be warranted.
社会隔离已被确定为一个主要的健康问题，尤其是在老年人中。在本研究中，我们研究了老年初级保健患者中社会隔离与患者体验之间的关系。
本横断面研究在日本的一个初级保健实践基础研究网络（28 个诊所）中进行。我们使用简化的 Lubben 社会网络量表评估社会隔离，使用日本版初级保健评估工具（JPCAT）评估初级保健患者的体验，该工具包括 6 个领域：初次接触、连续性、协调性、全面性（提供的服务）、全面性（提供的服务）和社区导向。我们使用线性混合效应模型调整诊所内的聚类和个体协变量。
对 465 名年龄≥65 岁的老年初级保健患者进行了数据分析。在调整可能的混杂因素和诊所内聚类后，社会隔离与 JPCAT 总分呈负相关，（平均差异=-3.67；95%置信区间，-7.00 至-0.38）。在 JPCAT 领域评分中，社会隔离与连续性、全面性（服务提供）和社区导向评分显著相关。
社会隔离与老年初级保健患者的负面患者体验相关。初级保健提供者应提高对患者社交网络的认识，针对社会隔离的老年患者进行有针对性的干预，旨在改善初级保健体验，特别是在连续性、全面性和社区导向方面，可能是必要的。
