Inequalities in access to health and social care among adults with multiple sclerosis: A scoping review of the literature

Abstract

words unstructured)Variations in access to health care are known to contribute to differences in life expectancy, morbidity and health-related quality-of-life across population subgroups. We undertook a scoping review to identify what is known about in-country variations in access to services for adults with multiple sclerosis and to identify gaps in the literature to inform future research and national policies. We searched MEDLINE, CINAHL, EMBASE, PSYCHINFO, SocINDEX and Social Science Abstracts from inception to end of December 2016 for quantitative studies which had investigated differences in access to prevention services, healthcare services, treatments and social care between inequality groups, defined using the PROGRESS-PLUS framework. A total of 4959 unique abstracts yielded 36 papers which met our eligibility criteria. Only 3 studies were cohort studies and only 4 were populationbased; most were from the United States (n=27). There were 6 studies on access to MS focused care and 6 on access to Disease Modifying treatments. There were 3 studies on access to prevention/lifestyle programmes and none on access to welfare services or information support. There were no papers examining inequalities in access for 'vulnerable' groups, such as, those with learning disability. In the available studies, there was evidence of inequalities in access to services with a trend for worse access among men, older age groups, those from lower socioeconomic groups or the least educated, non-caucasians, those with mental health problems and those from rural areas. In the studies on access to disease modifying treatments, older age and lower socioeconomic status were consistently associated with a lower rate of uptake, while race and gender were not. Inequalities or disparities in access to all levels of services and treatments will need to be addressed through a strategic research agenda with an emphasis on populationbased studies and development and evaluation of interventions to reduce inequality.3

Health service utilization in immigrants with multiple sclerosis

“…Individuals with MS are expected to have higher rates of health services use compared to the general population, although many MS-related symptoms can be managed today on an outpatient basis [ 18 , 25 , 26 ]. In a previous scoping review of the literature, non-white race was associated with less access to health services in individuals with MS, although immigrant status was not investigated [ 9 ]. Studies of health service utilization may improve understanding of disparities across sociodemographic groups and in turn support policies to address those disparities.…”

“…In a previous scoping review of the literature, non-white race was associated with less access to health services in individuals with MS, although immigrant status was not investigated [9]. Studies of health service utilization may improve understanding of disparities across sociodemographic groups and in turn support policies to address those disparities.…”

“…Little is known about which sociodemographic factors predict favourable health service utilization in people living with multiple sclerosis (MS). In a previous scoping review of the literature, non-white race was associated with worse access to health services for people with MS, although only 3 of 36 included studies were cohort studies [9].…”

Barriers to access and utilization of multiple sclerosis care services in a large cohort of Latin American patients

“…11 Although prevalence rates vary widely among distinct LATAM population (as shown in Table 2), 2–4 MS is not generally recognized as a significant public health problem by sanitary authorities in the region, and therefore not considered a priority worthy of institutional support. 8 In addition to indirect costs of MS (impact of unemployment and decreased productivity), 7,12–15 PwMS often shoulder the burden of high out-of-pocket expenses for symptomatic treatment or chronic DMT purchase, complementary exams, MRI, medical technology, and medical visits (inpatient/outpatient). 7–9,16 Access to a wide range of clinical specialists and complementary exams is critical to ensure health and QoL in this patient group.…”

“…Furthermore, online collection of self-reported data likely favored sample selection bias toward younger patients, with higher levels of education and better employment, compared to samples of PwMS drawn from specialized centers. 11,14,29 Second, although a large cohort from 12 LATAM countries was identified, it does not necessarily reflect the entire LATAM population (e.g. there was absence of participation of Brazil in the study).…”