Evidence map›Paper›PMID 41039438›Full record

SynthesisInternational journal for equity in health2025

Mechanisms of inequitable access to parkinson's disease care: a critical interpretive synthesis.

Sharon Koehn, Neil Drummond, Lisa Jasper, Anh Nq Pham, Karen Leung, Denise Cloutier, Marguerite Wieler, C Allyson Jones

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in International journal for equity in health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Sharon KoehnDepartment of Family Medicine, University of Alberta, 6-10 University Terrace, Street, Edmonton, AB, 8303-112, T6G 2T4, Canada. skoehn@ualberta.ca.ORCID 0000-0001-8754-6767
Neil DrummondDepartment of Family Medicine, University of Alberta, 6-10 University Terrace, Street, Edmonton, AB, 8303-112, T6G 2T4, Canada.
Lisa JasperDepartment of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Street, Edmonton, AB, 8205-114, T6G 2G4, Canada.ORCID 0000-0002-6671-4466
Anh Nq PhamPacific Institute of Pathogen, Pandemic and Society, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.ORCID 0000-0002-8967-513X
Karen LeungDepartment of Family Medicine, University of Alberta, 6-10 University Terrace, Street, Edmonton, AB, 8303-112, T6G 2T4, Canada.ORCID 0000-0002-3365-9245
Denise CloutierDepartment of Geography, University of Victoria, David Turpin Building, Room B203, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.ORCID 0000-0001-6065-5234
Marguerite WielerDepartment of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Street, Edmonton, AB, 8205-114, T6G 2G4, Canada.ORCID 0000-0002-9949-9731
C Allyson JonesDepartment of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Street, Edmonton, AB, 8205-114, T6G 2G4, Canada.ORCID 0000-0002-3952-3234

Funding

CIHR Planning and Dissemination Grant - ICS (2023-2024)
6 · The paper itself

Abstract

backgroundParkinson's disease (PD) is a leading cause of neurological disability among older adults, with an age-standardized global prevalence in 2021 of 139/100,000 and projected to increase by 112% by 2050. People living with PD experience seven times worse health status than the general population. Access to diagnosis, care, and support is particularly challenged by intersecting social and healthcare system complexities. This Critical Interpretive Synthesis aimed to identify mechanisms through which barriers interact to create inequitable access to PD care among underserved populations.

methodsWe searched five bibliographic databases (MEDLINE, Embase, CINAHL, PsychINFO, and Scopus) for English-language sources (2005 to 2024). Inclusion criteria encompassed peer-reviewed articles, books, dissertations, and organizational reports mentioning underserved older adults with PD and their care partners. Analysis followed Critical Interpretive Synthesis methodology, combining systematic review strategies with meta-ethnography and grounded theory techniques. Two investigators independently screened citations, with analysis guided by Candidacy 2.0 and Intersectionality frameworks.

resultsOf 1,281 identified studies, 96 met inclusion criteria. United States studies dominated (56%), with quantitative analyses of electronic medical records comprising 66% of evidence. Analysis revealed three interrelated mechanisms shaping access inequities: (1) complex interplay between regional factors and healthcare delivery systems creating variable landscapes of access, (2) provider biases and judgments serving as critical gatekeeping points, and (3) intersectional effects of multiple marginalized identities compounding disadvantage. These mechanisms interact systematically, creating self-reinforcing cycles where social marginalization increases both disease progression and barriers to appropriate care.

conclusionsImproving PD care access requires coordinated interventions addressing multiple intersecting barriers simultaneously. For policy and management, this includes targeted funding for infrastructure, systematic provider education addressing knowledge gaps and biases, and integration of community-based solutions with formal healthcare. Future research should examine how informal care networks can enhance access in diverse healthcare contexts. REGISTRATION: The scoping review on which this Critical Interpretive synthesis builds is registered with Open Science Framework: https://doi.org/10.17605/OSF.IO/2T7KG .

Indexed as

Healthcare DisparitiesHealth Services AccessibilityParkinson DiseaseHumansCritical interpretive synthesisGeographic disparitiesHealthcare accessHealth equityIntersectionalityMarginalized populationsParkinson's diseaseProvider bias

Identifiers

PMID41039438
PMCPMC12492797

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.