| Popis: |
Aging in place has long been a policy objective in Canadian healthcare, with accompanying concerns about older adults in rural and remote regions, and growing interest in small urban areas as distinct from large urban ones. As one of the six health authorities in British Columbia (BC), Interior Health (IH) developed and implemented an innovative healthcare delivery model to support aging in place for older adults, while addressing system issues of cost containment and resource allocation. By transferring funds from acute care to primary care, IH created Seniors Health and Wellness Centres (SHWCs) in two small urban areas (Kelowna and Kamloops) and a third one with two rural sites (Salmon Arm and Revelstoke). Our multi-case study aimed to compare how the SHWCs are meeting their objectives, and addressing the priorities of rural and small urban older adults and their social determinants of health (SDoH). We used mixed methods of data collection and analysis, including key informant interviews (n=9), service user questionnaires (n=10), document analysis (n=19), and secondary data analysis of service usage (n=2343) to answer research questions (RQs) on the outcomes and impacts of IH’s restructuring. The results show the outcomes (RQ1) to be three SHWCs which vary considerably in their design and usage, including access, quality, and continuity of care. Our findings on the impacts (RQ2) indicate the SHWCs are meeting their cost reduction aims while concentrating on some SDoH (income & dis/ability) and neglecting others (gender, racism, rurality), and progressing slowly in addressing certain priorities of older adults. |
