Scoping review on primary care interventions to reduce health inequities

Although evidence indicates that primary care–based health systems are more effective at reducing social inequities, implementing changes to achieve this remains complex. We aimed to provide key information on the design of context-aware, equity-centred interventions in primary care. We conducted a scoping review following the methodological framework of Arksey and O’Malley and the PRISMA-ScR guidelines. A comprehensive search of PubMed, SCOPUS, and Web of Science for interventions designed to prevent or reduce health inequities in primary care settings was conducted. Studies were selected according to predefined inclusion criteria. Seventy-three studies were included in the evidence synthesis. Interventions were highly heterogeneous. Most involved expanding primary care teams with additional health workers. A second major group comprised interventions with three or more multidisciplinary components focused on prevention or patient management. Nearly half aimed to improve access to preventive care, and almost one fifth focused on a single disease (T2DM). Few studies assessed interventions targeting structural factors. Only 27% of interventions were evaluated through randomised controlled trials. The majority of the reviewed interventions were constrained in scope, as they were relatively simple in design and primarily targeted populations defined by a narrow set of vulnerability characteristics. The scarcity of evaluations of complex interventions addressing structural factors and the paucity of interventions targeting heterogeneous populations highlight the need for further research in these areas.