P2‐491: UNDERSTANDING THE ROLE OF PRIMARY CARE IN SOCIALLY ISOLATED OLDER ADULTS IN RURAL JAMAICA: A MIXED METHODS STUDY
Bibliographic record
Abstract
Aging societies are a global phenomenon, and threats to inclusive aging are emerging as a major primary health concern. With countries seeing a shift in their epidemiologic profile, chronic medical conditions increase with age, which lead to functional impairments that reduce the ability to access medical care. This isolation is compounded when a person has little social support and financial resources. These access barriers lead to missed appointments and fragmented care, exacerbating the effects of pre-existing conditions. Social isolation negatively impacts the physical well-being of older adults. The objective of this study was to explore the role of primary care on improving access to care of isolated older people in Jamaica. A convergent multi-method approach included (i) a cross-sectional self-administered survey of physicians, (ii) in-depth interviews with socially isolated older adults, (iii) a focus group of community health aides, (iv) key informant interviews with primary care physicians. There was an 80% survey response rate with 35% of physicians [n= 21/60] seeing older adults as vulnerable. Physicians agreed that it was the role of health workers to inquire about the underlying social challenges of their patients (n=43/60, 71.7%], but were divided on the physicians' subjective responsibility beyond referral, with some believing this was sufficient while others advocated for home visits [Kruskal-Wallis c2= 16.775; df=2, p= 0.05, c2= 5.991]; [obs. diff 22.180, critical diff 16.098]. Hypothesis testing revealed that physicians with longer consultation times and those who previously delivered home health care were more likely to advocate for a home-based primary care intervention [p <0.001]. Isolated older adults required more from their physicians, stating "I'd like my doctor to ask what's going on in my life, beyond checking my pressure."
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".