Factors Affecting Access to Neurosurgical Care in Diverse Communities in Canada: A Qualitative Scoping Review.

Abstract

Introduction: Access to neurosurgical care is essential for addressing elective and non-elective neurosurgical conditions. Disparities in healthcare access in Canada persist, disproportionately affecting rural, Indigenous and socioeconomically disadvantaged populations. This scoping review sought to identify barriers and facilitators influencing neurosurgical access to care while highlighting gaps in the literature on equity-deserving groups.

Methods: A systematic literature search of articles published from January 2000 to August 2024 was conducted using MEDLINE, EMBASE, Cochrane Library, PsycINFO and Scopus. Gray literature from governmental and non-governmental organizations was also reviewed. Of 1400 identified records, eight studies met the inclusion criteria. These studies were analyzed using inductive coding and thematic analysis to explore socioeconomic, geographic, racial, gender-based and cultural barriers.

Results: Four major themes emerged: delays in access, alternative healthcare options, policy barriers and communication and coordination. Barriers including transportation gaps, socioeconomic inequities and systemic discrimination were prominent, especially for rural and Indigenous populations. Facilitators like telehealth and improved inter-hospital coordination showed promise but were hindered by infrastructure limitations and cultural misalignments. Few studies addressed the intersectionality of these barriers, highlighting gaps in understanding their cumulative impact.

Conclusion: The findings in this review underscore the need for systemic reforms, including equitable resource allocation, digital infrastructure expansion and culturally congruent care. Addressing these barriers is critical to ensuring timely and equitable neurosurgical care across Canada. Future research should prioritize intersectional approaches to better understand overlapping access challenges and evaluate the efficacy of tailored interventions.