Jahnavi Shriram1, James Kelbert1, Dalia Koujah1, Dominic Julian1, Jennifer Hartmark-Hill2
1University of Arizona College of Medicine Phoenix, 2Family Community & Preventive Medicine, University of Arizona College of Medicine Phoenix
Objective:
The goal of this review is to identify existing screening tools, needs assessments, and other methods used to quantify unmet demand for neurological care in populations facing social determinants of health (SDoH)-related barriers. We seek to describe where, when, and how these methods have been implemented. We additionally aim to identify strengths and weaknesses in existing methodologies.
Background:
The American Academy of Neurology recently published a call to action to address a critical shortage of neurologists relative to the demand for specialty neurological care. There are limited methods to characterize the burden of this unmet demand, particularly in populations facing SDoH-related barriers to care.
Design/Methods:
In the preliminary arm of this scoping review, we completed an electronic search in PubMed. At least two reviewers screened each included article. Using a grounded theory approach, we identified strengths and weaknesses from each article, and developed unifying principles.
Results:
64 out of 1419 screened articles were included in this review. We report on the distribution of neurological subspecialties, SDoH-related barriers, and geographic regions represented in the included articles. We additionally constructed a basic care pathway framework for patients seeking neurological care, and categorized included articles based on at which level of this care pathway they assessed gaps.
Conclusions:
There appears to be a lack of rigorous, validated tools to assess unmet demand for neurological care. All articles proposed methodologies to define and assess unmet demand for neurological care. However, only a small fraction developed a specific, cohesive tool attempting to quantify these discrepancies in order to effectively direct distribution of resources. Synthesized from lessons learned in the reviewed literature, we discuss recommendations for further research to design a comprehensive screening tool of unmet neurological care demand.