Interacting determinants shaping inequities in rural primary care access in high-income countries: a scoping review

Inequities in access to primary care persist for populations living in rural and remote areas of high-income countries. While barriers such as geographic distance, workforce shortages, and cost are well documented, they are often examined in isolation, limiting understanding of how they interact to shape inequities in access. To map contemporary evidence on barriers and enablers influencing primary care access in rural and remote communities across high-income countries, with a focus on how these factors interact to shape inequities. A scoping review was conducted following Joanna Briggs Institute methodology and reported in accordance with PRISMA-ScR guidelines. Scopus, MEDLINE, PubMed, Embase, ProQuest, and CINAHL were searched for peer-reviewed studies published in English between 2017 and 2026. Using a Population–Concept–Context framework, studies examining access to primary care in rural and remote populations in high-income countries were included. Data were synthesised using descriptive thematic analysis. Forty-seven studies met the inclusion criteria, most conducted in Australia, with additional studies from the United States, Canada, and multinational contexts. Five interrelated domains were identified: geographic and transport factors; workforce and service availability; financial and business conditions; cultural determinants; and health system and policy structures. These domains interacted across individual, organisational, and system levels. Geographic isolation, workforce shortages, and funding constraints frequently co-occurred, contributing to reduced service availability and continuity of care. Community-controlled and culturally safe models of care were identified as important enablers for Indigenous populations. Telehealth showed potential to reduce geographic barriers, although its effectiveness depended on infrastructure, workforce capability, and organisational capacity. Access to primary care in rural and remote settings is shaped by interacting structural, organisational, and relational conditions that generate and sustain inequities. Addressing these inequities is likely to require coordinated, systems-oriented policy responses integrating workforce, funding, service delivery, and culturally appropriate care across health system levels.