背景:对于许多西方国家来说,医疗沙漠被认为是一个有问题的问题,这些国家试图采用多种政策和举措来实现其卫生劳动力(HWF)的更好分配。这项研究的目的是系统地绘制研究图,并提供定义的概述,特点,在欧盟(EU)资助的项目“ROUTE-HWF”(将MEdical沙漠纳入支持性健康工作者计划和政策的路线图)中减轻医疗沙漠的因素和方法。
方法:我们进行了范围审查,以确定医学沙漠领域的知识集群/研究空白,重点关注HWF问题。截至2021年6月,共搜索了6个数据库。报告西方国家关于定义的主要研究的研究,特点,促成因素,和方法都包括在内。两名独立审稿人评估了研究的资格,根据四个定义的结果提取数据和聚类研究。
结果:纳入了240项研究(n=116,48%澳大利亚/新西兰;n=105,44%北美;n=20,8%欧洲)。除五项准实验研究外,所有研究均使用观察性设计。研究提供了定义(n=171,71%),特征(n=95,40%),影响因素(n=112,47%),以及缓解医疗沙漠的方法(n=87,36%)。大多数医疗沙漠是由一个地区的人口密度定义的。导致医疗沙漠中HWF问题的因素包括HWF的工作相关因素(n=55,23%)和生活方式相关因素(n=33,14%)以及社会人口统计学特征(n=79,33%)。减轻这些影响的方法侧重于适应农村实践范围的培训(n=67,28%),HWF分布(n=3,1%),支持/基础设施(n=8,3%)和创新护理模式(n=7,3%)。
结论:我们的研究提供了第一个范围审查,介绍和分类定义,特点,促成因素,以及缓解医疗沙漠中HWF问题的方法。我们发现了差距,例如缺乏纵向研究来调查导致医疗沙漠的因素的影响,和干预研究,以评估缓解HWF问题的方法的有效性。
BACKGROUND: Medical deserts are considered a problematic issue for many Western countries which try to employ multitude of policies and initiatives to achieve a better distribution of their health workforce (HWF). The aim of this study was to systematically map research and provide an overview of definitions, characteristics, contributing factors and approaches to mitigate medical deserts within the European Union (EU)-funded project \"ROUTE-HWF\" (a Roadmap OUT of mEdical deserts into supportive Health WorkForce initiatives and policies).
METHODS: We performed a scoping
review to identify knowledge clusters/research gaps in the field of medical deserts focusing on HWF issues. Six databases were searched till June 2021. Studies reporting primary research from Western countries on definitions,
characteristics, contributing factors, and approaches were included. Two independent reviewers assessed studies for eligibility, extracted data and clustered studies according to the four defined outcomes.
RESULTS: Two-hundred and forty studies were included (n=116, 48% Australia/New Zealand; n=105, 44% North America; n=20, 8% Europe). All used observational designs except for five quasi-experimental studies. Studies provided definitions (n=171, 71%),
characteristics (n=95, 40%), contributing factors (n=112, 47%), and approaches to mitigate medical deserts (n=87, 36%). Most medical deserts were defined by the density of the population in an area. Contributing factors to HWF issues in medical deserts consisted in work-related (n=55, 23%) and lifestyle-related factors (n=33, 14%) of the HWF as well as sociodemographic characteristics (n=79, 33%). Approaches to mitigate them focused on training adapted to the scope of rural practice (n=67, 28%), HWF distribution (n=3, 1%), support/infrastructure (n=8, 3%) and innovative models of care (n=7, 3%).
CONCLUSIONS: Our study provides the first scoping
review that presents and categorizes definitions,
characteristics, contributing factors, and approaches to mitigate HWF issues in medical deserts. We identified gaps such as the scarcity of longitudinal studies to investigate the impact of factors contributing to medical deserts, and interventional studies to evaluate the effectiveness of approaches to mitigate HWF issues.