Access to specialty healthcare in urban versus rural US populations: a systematic literature review

Abstract

BackgroundAccess to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between US urban versus rural specialty care. We summarize recent literature and expand upon a prior conceptual access framework, adapted here specifically to urban and rural specialty care.MethodsA systematic review was conducted of literature within the CINAHL, Medline, PubMed, PsycInfo, and ProQuest Social Sciences databases published between January 2013 and August 2018. Search terms targeted peer-reviewed academic publications pertinent to access to US urban or rural specialty healthcare. Exclusion criteria produced 67 articles. Findings were organized into an existing ten-dimension care access conceptual framework where possible, with additional topics grouped thematically into supplemental dimensions.ResultsDespite geographic and demographic differences, many access facilitators and barriers were common to both populations; only three dimensions did not contain literature addressing both urban and rural populations. The most commonly represented dimensions were availability and accommodation, appropriateness, and ability to perceive. Four new identified dimensions were: government and insurance policy, health organization and operations influence, stigma, and primary care and specialist influence.ConclusionsWhile findings generally align with a preexisting framework, they also suggest several additional themes important to urban versus rural specialty care access.

Assessment of Pediatrician Awareness and Implementation of the Addendum Guidelines for the Prevention of Peanut Allergy in the United States

“… 10 Because a negative result has an extremely low risk of reaction (more than 90% negative predictive value), 19 pediatricians can safely recommend peanut introduction, thus reducing the need for allergy referrals and avoiding possible bottlenecks. 20 Previous research has indicated that both urban and rural areas face challenges in accessing specialty health care services, 21 therefore pediatricians who screen for peanut allergy could help provide an allergy assessment for more infants. If the sIgE test result is positive, an infant may or may not be allergic to peanut and should be referred to an allergist for further assessment.…”

A mixed methods analysis of access barriers to dermatology care in a rural state

“…Few healthcare personnel (0.5%), interviewed patients (1.7%), and surveyed patients (0.9%) reported culture or stigma-related care barriers or facilitators, and none reported language. The distributions of barriers across themes also differed significantly between our results from interviews, surveys, and a systematic review of the rural specialty literature (Cyr, Etchin, et al, 2019 TA B L E 3 (Continued) have inherent risks for personal bias, although our use of a team approach, interview scripts, and deviant cases (2 favourable, 2 poor outcomes) limit this possibility.…”

“…and (c) Does the distribution of these care access determinants vary from conceptual frameworks in the prior literature, and if so, how? (Cyr, Etchin, et al, 2019;Levesque et al, 2013).…”

Accessibility Of Social Rights: Analysis Of Perceptions Of Young People

“…Researchers note that access to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between urban versus rural specialty care (Cyr, Etchin, Guthrie, & Benneyan, 2019). They say that long delays or complete inaccessibility to primary and specialty care are common across the United States (Kablan, Oulaï, & Elliott, 2015;Steinman, Shoben, Dembe, & Kelleher, 2015).…”