A systematic review of barriers to optimal outpatient specialist services for individuals with prevalent chronic diseases: what are the unique and common barriers experienced by patients in high income countries?

Abstract

Health utilization and need assessment data suggest there is considerable variation in access to outpatient specialist care. However, it is unclear if the types of barriers experienced are specific to chronic disease groups or experienced universally. This systematic review provides a detailed summary of common and unique barriers experienced by chronic disease groups when accessing and receiving care, and a synthesized list of possible health service initiatives to improve equitable delivery of optimal care in high-income countries. Quantitative articles describing barriers to specialist outpatient services were retrieved from CINAHL, MEDLINE, Embase, and PyscINFO. To be eligible for review, studies: were published from 2002 to May 2014; included samples with cancer, diabetes mellitus, osteoporosis, arthritis, ischaemic heart disease, stroke, asthma, chronic pulmonary disorder (COPD) or depression; and, were conducted in high-income countries. Using a previously validated model of access (Penchansky and Thomas’ model of fit), barriers were grouped according to five overarching domains and defined in more detail using 33 medical subject headings. Results from reviewed articles, including the scope and frequency of reported barriers, are conceptualized using thematic analysis and framed as possible health service initiatives. A total of 3181 unique records were screened for eligibility, of which 74 studies were included in final analysis. The largest proportion of studies reported acceptability barriers (75.7 %), of which demographic disparities (44.6 %) were reported across all diseases. Other frequently reported barriers included inadequate need assessment (25.7 %), information provision (32.4 %), or health communication (20 %). Unique barriers were identified for oncology, mental health, and COPD samples. Based on the scope, frequency and measurement of reported barriers, eight key themes with associated implications for health services are presented. Examples include: common accommodation and accessibility barriers caused on service organization or physical structure, such as parking and appointment scheduling; common barriers created by poor coordination of care within the healthcare team; and unique barriers resulting from inadequate need assessment and referral practices. Consideration of barriers, across and within chronic diseases, suggests a number of specific initiatives are likely to improve the delivery of patient-centered care and increase equity in access to high-quality health services.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-015-0179-6) contains supplementary material, which is available to authorized users.

Barriers to accessing primary health care: comparing Australian experiences internationally

“…Barriers to access can happen because of problems with attributes of services or abilities of people. There is a growing body of research using this framework to assess access to primary care more broadly (Fradgley et al 2015;Ward et al 2015).…”

Comprehensive review on cardio-oncology: Role of multimodality imaging

“…In fact, a significant percentage of oncology patients reported lack of inclusion in making treatment decisions (47%), lack of effective information on the probability of cancer therapy-related side effects (49%), and management of side-effects (38%). 118 In addition, clinician inertia and lack of cardiology referral are not exclusive to nonacademic medical centers. In a retrospective chart review of 88 patients who received anthracycline or trastuzumab at Stanford University from October 2005 to October 2007, 40% developed LV systolic dysfunction (\55%) after anthracycline and/or trastuzumab treatment.…”

“…(Reproduced with permission from John Wiley and Sons publishing, from Catheterization and Cardiovascular Interventions). care of cancer patients, 118 one potential strategy for improving CV management of the oncology patient may be utilization of cancer navigator specialists, to enhance coordination of care in this particularly vulnerable patient population. Recent studies exploring the impact of cancer nurse navigators documented improvement in timely and appropriate care, through reduced referral times and increased molecular testing to facilitate the delivery of first-line targeted therapy in lung cancer patients, 120 as well as in breast cancer patients.…”

“…In a recent systematic review of barriers to optimal outpatient specialist services for patients with prevalent chronic diseases, inadequate needs assessment and failure of physician referral for specialty care were two unique obstacles faced by oncology patients. 118 Only one in two cancer patients were referred for social Figure 7. Algorithm for patient management after chest radiotherapy.…”

Models of care for severe asthma: the role of primary care

“…Referral to a specialist should be initiated for patients with severe or difficult asthma or suspicion of alternative or coexisting disease, including chronic obstructive pulmonary disease (Box 4). Barriers to timely respiratory physician review may include unclear reason for referral, travel distance, patient factors and lengthy waiting lists 31 . GPs hold an important role as advocates for their patients in securing a prioritised review at the appropriate clinic, especially in a tertiary hospital setting.…”