The inverse care law and the potential of primary care in deprived areas

Mercer, Stewart W; Patterson, John E.; Robson, John; Smith, Susan M; Walton, Elizabeth; Watt, Graham

doi:10.1016/s0140-6736(21)00317-2

Cited by 33 publications

(29 citation statements)

References 13 publications

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“…Deep End practices serve populations living in areas of blanket deprivation with high proportions of patients living in the 15% most deprived local areas, based on postcode data. The NENC Deep End network was inspired by the GPs at the Deep End network in Scotland: a forum for advocacy, sharing ideas and developing interventions to mitigate health inequalities [11,12]. Since the founding of the original Scottish network in 2009, Deep End GP networks have been founded in several other regions of the UK, plus Ireland, Australia and Canada.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

Norman

Wildman

Sowden

2021

IJERPH

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COVID-19 is disproportionately impacting people in low-income communities. Primary care staff in deprived areas have unique insights into the challenges posed by the pandemic. This study explores the impact of COVID-19 from the perspective of primary care practitioners in the most deprived region of England. Deep End general practices serve communities in the region’s most socioeconomically disadvantaged areas. This study used semi-structured interviews followed by thematic analysis. In total, 15 participants were interviewed (11 General Practitioners (GPs), 2 social prescribing link workers and 2 nurses) with Deep End careers ranging from 3 months to 31 years. Participants were recruited via purposive and snowball sampling. Interviews were conducted using video-conferencing software. Data were analysed using thematic content analysis through a social determinants of health lens. Our results are categorised into four themes: the immediate health risks of COVID-19 on patients and practices; factors likely to exacerbate existing deprivation; the role of social prescribing during COVID-19; wider implications for remote consulting. We add qualitative understanding to existing quantitative data, showing patients from low socioeconomic backgrounds have worse outcomes from COVID-19. Deep End practitioners have valuable insights into the impact of social distancing restrictions and remote consulting on patients’ health and wellbeing. Their experiences should guide future pandemic response measures and any move to “digital first” primary care to ensure that existing inequalities are not worsened.

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Section: Introductionmentioning

confidence: 99%

COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

Norman

Wildman

Sowden

2021

IJERPH

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“…The inverse care law persists in most health systems whereby patients in poorer areas who have more complex and multifactorial problems are less likely to have their unmet needs addressed because of the maldistribution of the health workforce and other resources. 7 Patients who live in rural or remote areas may have lower expectations and may be less able to adhere to treatment, while encountering greater clinician-level barriers (eg, suboptimal physician capacity, incompetent health care workforce, and greater stress among health care professionals) and system-level barriers (eg, poor accessibility of integrated services and lack of coordination of care) than patients who live in urban areas. These barriers may act together, rather than in isolation, to hinder the personalization and prioritization of care to deliver what really matters to individual patients, resulting in suboptimal health care in rural areas of high socioeconomic deprivation with exacerbated health and social disparities.…”

Section: + Related Articlementioning

confidence: 99%

Understanding Barriers to Adherence to Optimal Treatment of Elevated Blood Pressure and Hypertension—Insights From Primary Care

Wang

Mercer

2021

JAMA Netw Open

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Lifestyle modifications, including the restriction of dietary sodium intake, have been recommended worldwide as first-line treatment for people with elevated blood pressure. 1 Recent evidence has further confirmed the benefits of salt substitutes in terms of reduced rates of stroke, major cardiovascular events, and death. 2 The study by Liu et al 3 explores the acceptability of, and adherence to, a salt substitute as well as the barriers to sodium reduction. In this mixed-methods investigation conducted in rural China, participants from the Salt Substitute and Stroke Study were used. 2 A total of 1025 participants completed the knowledge, attitude, and practice questionnaire regarding salt intake, while 30 participants receiving salt substitutes completed qualitative interviews. Despite finding that the overall acceptability of the use of salt substitutes in daily life among rural participants was high, an inadequate awareness of the recommended daily salt intake was reported. In addition, participants commonly reported being unaware of the health benefits of consuming salt substitutes and reported still favoring the use of regular salt when preparing pickled foods. Barriers to sustainable adoption of salt substitutes included insufficient health education, self-perceived high costs, and contextual factors (such as preference for habitual flavors of food). The authors suggested that these barriers should be taken into account in formulating sodium reduction strategies in rural areas.

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“…It is 50 years since Julian Tudor-Hart described the inverse care law, and its relevance is as great today as it was then. 9 Although Tudor-Hart wrote about the 'availability of good medical care', the challenges of an ageing population make the 'availability of good integrated health and social care' increasingly central.…”

Section: Deprivation and Health Inequalitiesmentioning

confidence: 99%

“…Patients living in deprived areas have more multimorbidity, and this occurs some 10-15 years earlier than in patients in affluent areas, 1 yet receive poorer quality of health care from the NHS than those who are better off. 9 It is unclear whether a similar inverse care law exists in social care, 10 but it seems likely given the complex funding arrangements and largely private provision. Integration of health and social care is likely to be much harder in socioeconomicallydeprived communities with multiple needs (commonly spanning mental, physical, and social problems).…”

Section: Deprivation and Health Inequalitiesmentioning

confidence: 99%