Abstract
Background: Social isolation is a global issue and a well-established predictor of adverse health outcomes, including increased risk of physical and mental health challenges, as well as mortality. However, less is known about its role as a predictor of healthcare experience and access, particularly within integrated care settings. This study aims to investigate social isolation as a predictor of patient experience within an integrated care model.
Approach: In April 2019, the Ontario Ministry of Health introduced Ontario Health Teams (OHTs), an initiative aimed at creating collaborative, integrated healthcare teams that connect patients to more coordinated and accessible care. To evaluate patient experiences within this model, a comprehensive survey was disseminated to individuals receiving care within an OHT. The survey, which contained 56 questions, assessed sociodemographic factors, healthcare service usage, patient health status, and healthcare experiences during transitions in care. Of the 35,350 individuals invited to participate, 2,911 responses were analyzed. Social isolation (measured using the UCLA 3-item loneliness scale) was examined as a predictor of key healthcare experience outcomes using binary logistic regression models, adjusting for patient demographics.
Results: 17% of respondents reported experiencing high levels of social isolation. Regarding access to care, 30% of respondents indicated that the wait time to see their regular healthcare provider was ""somewhat"" or ""much too long."" Most respondents felt positively about their healthcare experience, with the large majority (93%) stating that their healthcare provider understood their needs ""somewhat"" or ""very well."" Additionally, 89% believed that their healthcare was ""somewhat"" or ""very coordinated,"" and 94% were confident in their ability to manage their own health. After adjusting for patient demographics (including health and mental health status, age, gender, race, and financial instability), the regression analyses revealed that for every one-unit increase in social isolation, the odds of reporting the wait time for accessing healthcare as ""about right"" decreased by 5.5% (OR=0.945, p=0.017). Similarly, the odds of feeling that healthcare providers understood patient needs ""somewhat well"" or ""very well"" decreased by 9.1% for each one-unit increase in social isolation (OR=0.91, p=0.009). Social isolation was also associated with a 7.8% reduction in the odds of perceiving care as ""somewhat"" or ""very coordinated"" (OR=0.925, p=0.013). Lastly, for each unit increase in social isolation, confidence in managing one’s health decreased by 13% (OR=0.87, p=0.0012).
Implications: Higher levels of social isolation are associated with poorer healthcare experiences, including longer perceived wait times, reduced feelings of being understood by healthcare providers, lower perceptions of care coordination, and diminished confidence in managing personal health. These findings highlight the importance of addressing social isolation in integrated care models to improve patient experiences and outcomes.