Rural primary care: a scoping review

Abstract

Abstract Background Access to primary care is unequally distributed. Especially in rural and remote areas access to primary care services is problematic. As many countries, large and small, recognize the challenge of providing accessible and good quality primary care and implement different strategies to address this challenge, there are opportunities for cross-national learning. The main aim of this report is to provide information on best practices and solutions to counter the risk of a primary care vacuum in rural and remote areas. Methods In this scoping review of the literature on primary care in rural areas we made an inventory of evidence from research of the past 10 years. The research literature from January 2008 to June 2018 was captured through searches of the databases of Medline, Cochrane and EMBASE. In addition, we included relevant grey literature from within the WHO European region. Results The following four groups of strategies have been identified and can be used to address rural primary care shortages: substituting roles within multidisciplinary primary care teamssmart recruitment, retention and training strategies focused on staff in rural areasimplementing technological innovations in information and communicationas a short term solution: promoting the mobility of health care workers and patients Conclusions The evidence base with regard to interventions to improve access to primary care in rural areas is narrow, lacking sufficient methodologically sound research, making definitive conclusions about their effectiveness impossible. Additionally, the available evidence is biased towards programmes targeting physicians. Nevertheless, the literature does offer indications of promising intervention types, and provides valuable recommendations for their implementation. Key messages Implementation of strategies should always be accompanied by systematic monitoring of outcomes. Interventions should include primary care workers other than physicians.