Abstract：
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.
OBJECTIVE: The purpose of this systematic review is to explore the impact of self-referral and direct access pathways on inequalities in health care use.
METHODS: 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.
OBJECTIVE: The purpose of this systematic review is to explore the impact of self-referral and direct access pathways on inequalities in health care use.
METHODS: 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.
摘要：
背景：将自我转诊和直接获取作为改善患者获得专科服务的替代护理途径的兴趣日益增加。这些途径对健康不平等的影响尚不清楚。
目的：本系统综述的目的是探讨自我转诊和直接获取途径对医疗保健使用不平等的影响。
方法：三个数据库(OvidMedline，Embase,从2000年1月至2023年2月，对WebofScience）和灰色文献进行了系统搜索，报道了自我转诊和直接获得护理的途径。根据资格标准筛选标题和摘要，以确定评估对健康不平等影响的研究。全文回顾后，从符合条件的研究中提取数据，并使用ROBINS-I工具进行质量评估。
结果：搜索策略确定了2948篇文章。包括19条记录，覆盖七个国家和六个医疗服务。自我推荐和直接获取对不平等的影响参差不齐，这表明这种关系取决于患者和系统因素。通常，自我转诊途径和直接获取途径往往会扩大健康不平等。白色,年轻,受教育程度较低的女性更有可能自我推荐，加剧现有的健康不平等。
结论：自我转诊途径有扩大健康不平等的风险。需要进一步的研究来了解这种情况可能发生的上下文相关机制，探索减轻这种甚至狭窄的健康不平等的方法，以及了解对更广泛的医疗保健系统的影响。
目的：本系统综述的目的是探讨自我转诊和直接获取途径对医疗保健使用不平等的影响。
方法：三个数据库(OvidMedline，Embase,从2000年1月至2023年2月，对WebofScience）和灰色文献进行了系统搜索，报道了自我转诊和直接获得护理的途径。根据资格标准筛选标题和摘要，以确定评估对健康不平等影响的研究。全文回顾后，从符合条件的研究中提取数据，并使用ROBINS-I工具进行质量评估。
结果：搜索策略确定了2948篇文章。包括19条记录，覆盖七个国家和六个医疗服务。自我推荐和直接获取对不平等的影响参差不齐，这表明这种关系取决于患者和系统因素。通常，自我转诊途径和直接获取途径往往会扩大健康不平等。白色,年轻,受教育程度较低的女性更有可能自我推荐，加剧现有的健康不平等。
结论：自我转诊途径有扩大健康不平等的风险。需要进一步的研究来了解这种情况可能发生的上下文相关机制，探索减轻这种甚至狭窄的健康不平等的方法，以及了解对更广泛的医疗保健系统的影响。
