'Just lie there and die': barriers to access and use of general practitioner out-of-hours services for older people in rural Ireland

Abstract

Introduction: Demographic changes and shifting populationsmean growing numbers of older people are living alone in ruralareas. General practitioner (GP) out-of-hours (GPOOH) serviceshave an essential role in supporting older people to remain livingin their own homes and communities for as long as possible, butlittle is known about use of GPOOH services by this cohort. Thisresearch examines how rurality impacts accessibility and utilisationof GPOOH services by people aged 65 years or more in ruralIreland.Methods: Conducted in the mainly rural counties of Cavan andMonaghan in the north-east of Ireland, this research used a mixedmethods approach. Questionnaires and focus groups wereconducted with 48 older people in six locations across bothcounties. A thematic analysis was conducted on the data usingNVivo software.Results: The challenge for older rural populations includesdifficulties accessing transport and the limited availability ofsupport networks during times of a health crisis, especially atnight. The present findings show such challenges are furthercompounded by a lack of information about available services.Rurality complicates each of these challenges, because it adds tothe vulnerability of older adults. This is most acutely felt by thosewho live alone and those living the furthest from GPOOHtreatment centres. The most important concern for older people,when unwell outside doctor surgery hours, is the need for accessto medical care as quickly as possible. Inability to use GPOOHservices leads many older people to seek help from accident andemergency departments, where faster access to clinical care issometimes assumed.Conclusions: For rural-dwelling older people, becoming ill outside GP surgery hours is complex and the barriers faced areoften insurmountable at times of greatest need. Worries aboutaccessibility and lack of information give rise to a hesitancy to useGPOOH services in a population that is already known to bereluctant to ask for help, even when such help is justified. In turn,the lack of familiarity with what is a fundamental communityhealth service further impacts the willingness of older adults to callon GPOOH services for help when needed. Addressing the impactof rurality on access and use of out-of-hours medical services is essential to enable more older adults to live longer in their ruralhomes and communities, supported by services that areresponsive to their needs regardless of where they live. GivenGPOOH is the only current alternative out-of-hours medical serviceto accident and emergency departments, more research is urgentlyneeded on both accessibility of GPOOH services by older adultsand the impact of inaccessibility on use of emergency services byolder people in rural areas