Defining Medical Deserts: An International Consensus-Building Exercise

Abstract

Background

• Medical deserts are a significant challenge in public health and health systems.
• COVID-19 pandemic worsened the accessibility to health services.
• A shared global definition of medical deserts was missing prior to this study.
• The study aims to define medical deserts through a consensus process applicable worldwide.

Methods

• Utilized the Delphi exercise method for consensus.
• First Phase: Individual online meetings to identify, rank, and select relevant dimensions for defining medical deserts.
• Second Phase: Two rounds of surveys to achieve consensus, concluded in January 2023.
• External validation from stakeholders via email.

Results

• A consensus definition identifies five major dimensions of medical deserts:
  1. Insufficient human resources in health
  2. Lack of facilities
  3. Long waiting times
  4. Disproportionate high costs of services
  5. Socio-cultural barriers

Conclusions

• Addressing the five dimensions can help mitigate medical deserts.

Introduction

• Universal Health Coverage is a global issue; many live in medical deserts without necessary healthcare.
• The term "medical desert" is derived from "food desert," indicating areas with limited access to essential services.
• Lack of access leads to increased morbidity and mortality.
• There is no formal, universal definition of medical deserts, complicating policy targeting.
• Medical deserts lead to higher healthcare costs and economic burdens.
• Emigration of health professionals worsens medical deserts.

Methods

Study Design

• Delphi Exercise: Chosen for its ability to gather expert input and build consensus.
• Phase 1: Individual online meetings to identify dimensions such as economic accessibility and healthcare workforce.
• Phase 2: Surveys to refine and reach consensus on the definition.
• External validation was done to finalize the definition.

Selection of Delphi Panel

• Snowball sampling technique to select experts in relevant fields.
• The panel included experts from Europe, USA, and Africa.
• Required criteria: English fluency, 18+ years old, ongoing research in medical deserts.

Procedures

• Online meetings and email communication for all phases.
• Two rounds of surveys conducted to refine the definition to consensus.
• 80% agreement was the threshold for consensus.

Results

• Initial and final definitions of medical deserts were developed through expert feedback.
• Definition focuses on barriers such as scarcity of health professionals, limited facilities, and long waiting times.
• Medical needs might be partially or totally unmet due to these barriers.

Discussion

• This is the first study to create an internationally agreed-upon definition of medical deserts.
• The definition aids in research, policy-making, and healthcare planning.
• Suggested focus on human resource management and broader healthcare access.
• "Health deserts" proposed as a more inclusive term covering mental, social, and physical health.
• Addressing barriers like high costs and socio-cultural factors is essential.

Acknowledgements

• Thanks to stakeholders and external reviewers for their contributions.

Author Contributions

• Authors contributed variously in idea generation, consensus-building, and drafting.

Key Points

• Medical deserts defined by unmet healthcare needs due to barriers.
• Suggests "health deserts" for a more holistic term.

References

• The study references multiple scholarly sources to substantiate claims and provide context.