Mechanisms of inequitable access to parkinson’s disease care: a critical interpretive synthesis
Bibliographic record
Abstract
BACKGROUND: Parkinson's disease (PD) is a leading cause of neurological disability among older adults, with an age-standardized global prevalence in 2021 of 139/100,000 and projected to increase by 112% by 2050. People living with PD experience seven times worse health status than the general population. Access to diagnosis, care, and support is particularly challenged by intersecting social and healthcare system complexities. This Critical Interpretive Synthesis aimed to identify mechanisms through which barriers interact to create inequitable access to PD care among underserved populations. METHODS: We searched five bibliographic databases (MEDLINE, Embase, CINAHL, PsychINFO, and Scopus) for English-language sources (2005 to 2024). Inclusion criteria encompassed peer-reviewed articles, books, dissertations, and organizational reports mentioning underserved older adults with PD and their care partners. Analysis followed Critical Interpretive Synthesis methodology, combining systematic review strategies with meta-ethnography and grounded theory techniques. Two investigators independently screened citations, with analysis guided by Candidacy 2.0 and Intersectionality frameworks. RESULTS: Of 1,281 identified studies, 96 met inclusion criteria. United States studies dominated (56%), with quantitative analyses of electronic medical records comprising 66% of evidence. Analysis revealed three interrelated mechanisms shaping access inequities: (1) complex interplay between regional factors and healthcare delivery systems creating variable landscapes of access, (2) provider biases and judgments serving as critical gatekeeping points, and (3) intersectional effects of multiple marginalized identities compounding disadvantage. These mechanisms interact systematically, creating self-reinforcing cycles where social marginalization increases both disease progression and barriers to appropriate care. CONCLUSIONS: Improving PD care access requires coordinated interventions addressing multiple intersecting barriers simultaneously. For policy and management, this includes targeted funding for infrastructure, systematic provider education addressing knowledge gaps and biases, and integration of community-based solutions with formal healthcare. Future research should examine how informal care networks can enhance access in diverse healthcare contexts. REGISTRATION: The scoping review on which this Critical Interpretive synthesis builds is registered with Open Science Framework: https://doi.org/10.17605/OSF.IO/2T7KG .
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.194 | 0.335 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.008 | 0.006 |
| Bibliometrics | 0.045 | 0.023 |
| Science and technology studies | 0.004 | 0.014 |
| Scholarly communication | 0.019 | 0.016 |
| Open science | 0.006 | 0.010 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".