What impact do self-referral and direct access pathways for patients have on health inequalities
Bibliographic Data
| ID | 21467795 |
|---|---|
| Authors | Adam Harvey-Sullivan (0000-0002-4396-1958, Queen Mary University of London, corresponding author), Heidi Lynch (0000-0002-6492-9754, Queen Mary University of London), Abraham Tolley (0000-0002-4739-4575, University of Cambridge), Guy Gitlin-Leigh (Luton and Dunstable University Hospital NHS Foundation Trust), Isla Kuhn (0000-0002-2879-4020, University of Cambridge), John Ford (0000-0001-8033-7081, Queen Mary University of London) |
| Year | 2024 |
| Volume | 139 |
| Pages | 104951 |
| Publication date | 2024-01-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Health Policy (JOURNAL) |
| Journal identifiers | ISSN: 0168-8510 • E-ISSN: 1872-6054 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.healthpol.2023.104951 |
| PMID | 38096622 |
| OpenAlex | W4389699584 |
| Language | EN |
| Citations received | 4 |
| References cited | 37 |
BACKGROUND: There is increasing interest in self-referral and direct access as alternatives pathways to care to improve patient access to specialist services. The impact of these pathways on health inequalities is unknown. OBJECTIVES: The purpose of this systematic review is to explore the impact of self-referral and direct access pathways on inequalities in health care use. DESIGN: Three databases (Ovid Medline, Embase, Web of Science) and grey literature were systematically searched for articles from January 2000 to February 2023, reporting on self-referral and direct access pathways to care. Title and abstracts were screened against eligibility criteria to identify studies that evaluated the impact on health inequalities. Data were extracted from eligible studies after full text review and a quality assessment was performed using the ROBINS-I tool. RESULTS: The search strategy identified 2948 articles. Nineteen records were included, covering seven countries and six healthcare services. The impact of self-referral and direct access on inequalities was mixed, suggesting that the relationship is dependent on patient and system factors. Typically self-referral pathways and direct access pathways tend to widen health inequalities. White, younger, educated women from less deprived backgrounds are more likely to self-refer, exacerbating existing health inequalities. CONCLUSIONS: Self-referral pathways risk widening health inequalities. Further research is required to understand the context-dependent mechanisms by which this can occur, explore ways to mitigate this and even narrow health inequalities, as well as understand the impact on the wider healthcare system
Family medicine · Geography · Grey literature · Health care · Health services research · Inequality · MEDLINE · Political science · Public health · Referral · Chronic Disease Management Strategies · Healthcare Systems and Technology · Medicine · Nursing · Primary Care and Health Outcomes
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| Citations per year | 4 |
|---|---|
| Citation span | 2025 - 2026 (2) |
| Highly cited | No |