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. 2019 Dec 18;19(1):974.
doi: 10.1186/s12913-019-4815-5.

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

Melissa E Cyr  1 , Anna G Etchin  2 , Barbara J Guthrie  3 , James C Benneyan  4
Affiliations

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

Melissa E Cyr et al. BMC Health Serv Res. .

Abstract

Background: Access 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.

Methods: A 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.

Results: Despite 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.

Conclusions: While findings generally align with a preexisting framework, they also suggest several additional themes important to urban versus rural specialty care access.

Keywords: Conceptual framework; Health services accessibility; Rural care; Systematic literature review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A conceptual framework of access to healthcare. Reprinted with permission from “Patient-centred access to health care: conceptualizing access at the interface of health systems and populations,” by J.-F. Levesque, M. F. Harris, & G. Russell, 2013, International Journal for Equity in Health, 12(1), 5. Copyright [2013] by Levesque et al.; licensee BioMed Central Ltd
Fig. 2
Fig. 2
Article identification, inclusion, and selection flowchart
Figure 3
Figure 3
Frequency of access to specialty care dimensions, grouped by system-centric supply, patient-centric demand, and emergent themes. Avail, availability; Gov’t, government; PCP, primary care provider
Fig. 4
Fig. 4
A proposed hierarchical conceptual framework for access to US urban and rural specialty care
See this image and copyright information in PMC

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