Social health clinics in community pharmacy are one way to address the issue of loneliness in the era of digital healthcare, writes Jenny Kirschner
We are witnessing a seismic shift in patient care, with a tsunami of end-to-end digital healthcare solutions popping up all over social media feeds. The message is clear: here is an uber-convenient way for you to see a doctor, get a prescription and have it delivered to your front door without you needing to move from your couch.
The RACGP describes these on-demand telehealth as “a service where providers are offering general practice services through online platforms, including websites and mobile applications, which allow patients to directly contact a GP working for the service.” Another way to describe the on-demand service is by imagining a virtual clinic room.
Digital healthcare solutions are not limited to on-demand telehealth services. You can also find a suite of remote patient monitoring options where GPs and allied health professionals can monitor your condition and progress while you remain on your couch. For example, Bluetooth-powered health monitoring devices enable remote patient monitoring through blood pressure machines, blood glucose machines and pulse oximeters.
While these advances certainly add value, increasing convenience and enhancing convenience and access to healthcare, there is also the potential of collateral damage on the social health of patients. These models of healthcare remove the incidental face-to-face interactions between patient and care providers. In an era already challenged by loneliness, this new wave of screen-delivered healthcare will almost certainly come at the cost of connection and genuine relationships with healthcare professionals, widening the loneliness gap for all ages.
Loneliness is an aversive and subjective feeling of social isolation that arises when an individual perceives that the quality or quantity of social relationships is less than what they desire. If a person feels lonely, then they are lonely. Loneliness is not equivalent to social isolation, an objective measure of the number of friends, family, or other social connections that an individual has and the frequency of contact with these social connections.
Research shows that loneliness is as lethal as smoking 15 cigarettes per day, making it even more dangerous than obesity. Other effects on health include: a 29% increase in the incidence of coronary heart disease; a 32% increase in the risk of stroke; poorer cardiovascular health indicators such as elevated blood pressure; elevated cholesterol; and prediction of future poorer mental health severity including depression. Loneliness has also been shown to put people at greater risk of cognitive decline and dementia.
The problem of loneliness is not new, but it has been recognised as a signature concern of the COVID-19 pandemic and we are yet to learn the long-term impacts of lockdowns on future social habits. Now, a further thorn has been added to the loneliness epidemic with the explosion of digital healthcare delivery.
Jeffrey Hall, professor of communication studies at the University of Kansas, makes an analogy between the gut biome and the social biome. Prof Hall says the social biome “is the individual ecosystem of relationships and interactions that shapes our emotional, psychological and physical health. All your daily interactions with others, big and small, make up your social biome, and the pandemic has severely damaged most of ours”.
Some of these smaller and incidental social exchanges could include the visit to a doctor for a face-to-face chat, the regular conversations and chinwags with your local community pharmacy staff and the pleasant small talk with other allied health professionals. Prof Hall says that small talk is more socially nutritious than we think: “Small talk … (like) checking in with another person and letting them know that you’re glad that you’re sharing a space with them is absolutely critical to a sense of community, and to our sense of social nutrition.”
Social health clinic offerings in community pharmacy are one way we can address the issue of loneliness. The personal relationship between a pharmacy and its community is one of its most valuable assets. I have heard of pharmacies who set up knitting stations for patients, and others that have walking groups. Perhaps it’s time to formalise these relationships into social health clinic offerings? They could be an elixir to the challenge of loneliness and social isolation plaguing our communities.
These social health services need to be a compelling experience, enticing enough to get patients off the convenience of their couches and back into their local community pharmacy. Clinic services could include social prescribing, for example.
Imagine another social health clinic that uses virtual reality (VR) glasses in their clinic rooms to tackle isolation and loneliness. SilVR Adventures is a company that currently provides virtual reality experiences and activities to seniors in care facilities, tackling loneliness and social isolation by bringing people together (promoting socialising and bonding) through shared experiences in virtual reality.
Meanwhile in San Diego, researchers have used artificial intelligence (AI) to accurately predict loneliness by harnessing machine learning to classify the sentiment and emotions of speech. The pharmacy social health clinic could be used to help identify loneliness in family members of concern. But simply using artificial intelligence-based methods to detect and diagnose loneliness is not enough, as loneliness is fundamentally a social problem and it can be solved only with social solutions and changes. The patients identified as lonely would then be offered a range of other social health services such as social prescribing.
The opportunities for in-store social health clinics are only limited by imagination, creativity and perhaps funding models. If we consider the health implications and costs of loneliness, with Medicare costs in the USA (2017) arising from loneliness and social isolation estimated at US$6.7 billion annually (similar cost estimates are currently lacking in Australia), then perhaps we also need to create new funding models out of necessity.
The rapid growth of digital healthcare systems is likely to upset, and further fragment, our face-to-face engagements, chipping away at one’s social connectedness. The result is an unhealthy social biome, leaving people more lonely, socially malnourished and thirsty for meaningful contact. Social health clinic services would redefine the bricks-and-mortar pharmacy model, evolving the traditional pharmacy health services and clinic offerings towards the needs of our time.
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