Characteristics of Medical Deserts and Approaches to Mitigate Their Health Workforce Issues: A Scoping Review of Empirical Studies in Western Countries

Document Type : Review Article

Authors

1 Health Workforce and Organization Studies, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands

2 Avedis Donabedian Research Institute – UAB, Madrid, Spain

3 Innovation and Entrepreneurship InnoLab, University of Vaasa, Vaasa, Finland

4 Department of Health Policy and Management, Institute of Public Health, Jagiellonian University, Krakow, Poland

5 Department of Health Economics and Social Security, Institute of Public Health, Jagiellonian University, Krakow, Poland

6 School of Medicine, University of Zagreb, Zagreb, Croatia

7 Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands

8 Department of Sociology, Radboud University, Nijmegen, The Netherlands

Abstract

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%).

Conclusion 
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.

Keywords

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  • Receive Date: 10 June 2022
  • Revise Date: 28 November 2022
  • Accept Date: 30 May 2023
  • First Publish Date: 03 June 2023

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