Addressing the needs of vulnerable populations in healthcare. Evidence from mixed methods systematic reviews

Background Although vulnerable populations have been a focus in healthcare research for over 50 years little research has been conducted that has explored the link between chronic illness and healthcare inequalities. Vulnerability in relation to healthcare issues has been considered in terms of both a categorical approach based on certain individual intrinsic characteristics and a situational approach as individuals navigate the healthcare system. The link between healthcare inequalities and systematic differences in health between different groups has also been acknowledged. The aim of this work is to understand the needs, characteristics and situations that perpetuate health inequalities for vulnerable groups and to explore how health inequalities can be ameliorated. Methods The methodology underpinning this work draws on the discipline of evidence synthesis, specifically mixed methods systematic reviews (MMSRs). This offers a deeper understanding of findings from both qualitative and quantitative research. The MMSRs (n=5) that were included explored accessed to cancer services for adults with physical disabilities, end-of-life care for adults with severe mental illness, inpatient care for young people with complex mental health needs, mealtime assistance for older adults in hospital settings and continence care in acute settings for people living with dementia. The findings were brought together and framed in an innovative way using the vulnerable populations conceptual model (VPCM). The VPCM describes the relationships between the concepts of resource availability, relative risk and health status. This approach enabled an exploration of the healthcare inequalities that were encountered on navigating the healthcare system, either when accessing healthcare, including admission and discharge or whilst experiencing care in the acute hospital setting while at the same time acknowledging the impact of social or structural disadvantages. Result What is evident across the wider evidence base is that vulnerable populations can encounter substantial challenges navigating healthcare systems. Resource availability was often conceptualised as interactions and/or relationships with HCPs. This is of concern as the VCPM proposes that those who lack available resources are at increased risk of negative health outcomes (delays in diagnosis, higher rates of morbidity and pre-mature mortality). Conclusion Using the VCPM in this way has potential value to inform healthcare practice, and policy about the opportunities and resources needed to protect the health status of vulnerable populations. It is crucial that healthcare professionals understand the unique challenges involved in caring for potentially vulnerable populations and that they take measures to improve the quality of their interactions so that equitable care and treatment can be provided