Differences in patient access to and utilization of caregiving services: a scoping review

Caregiving services provide critical support for patients’ health needs and well-being. While studies have documented disproportionate access to and utilization of caregiving services for certain populations, the extent of these differences is not well understood. This scoping review assesses the differences and their extent in patient access to and utilization of paid and unpaid caregiving services. PubMed, CINAHL, EconLit, and Web of Science were searched for studies published between April 2017 and August 2024. Titles and abstracts underwent dual independent review. A single reviewer conducted full text screening and abstraction, which a second reviewer verified. Reviewers used DistillerSR software. We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses and Joanna Briggs Institute guidance for scoping reviews. The search identified 1,838 articles, and 92 met inclusion criteria. Most included studies focused only on paid caregiving services (n = 69, 75%). The most frequently reported differences in access to or utilization of caregiving services were by race/ethnicity (n = 47, 51%), medical condition (n = 45, 49%), and geographic location (n = 41, 45%). Studies generally reported that White patients had greater access to paid services than patients of other races but were less likely to use unpaid caregivers. Patients with poorer health, more comorbidities, and difficulties with activities of daily living were more likely to utilize services. Patients living in rural and socioeconomically disadvantaged areas faced challenges accessing services due to transportation issues and distance. Other characteristics examined include sex, age, insurance, income, education, disability, marital status, language, and living arrangement. This scoping review identified studies that captured differences in patient access to and utilization of caregiving services across groups, services, medical conditions, and settings. A comprehensive measure to gather data on access to caregiving services and a more systemized data capture around explanatory variables would help identify needs among individuals with different sociodemographic characteristics and medical conditions. Without sustained research, identifying how any single factor proportionately affects utilization is challenging. Continued assessments of caregiving services needed by patients with varying medical conditions are critical to improving the outcomes and experiences of patients and caregivers.