A Systematic Review of Interventions to Minimize Transportation Barriers Among People with Chronic Diseases

Abstract

Transportation is an important social determinant of health. Transportation barriers disproportionately affect the most vulnerable groups of society who carry the highest burden of chronic diseases; therefore, it is critical to identify interventions that improve access to transportation. We synthesized evidence concerning the types and impact of interventions that address transportation to chronic care management. A systematic literature search of peer-reviewed studies that include an intervention with a transportation component was performed using three electronic databases—PubMed, EMBASE, and CINAHL—along with a hand-search. We screened 478 unique titles and abstracts. Two reviewers independently evaluated 41 full-text articles and 10 studies met eligibility criteria for inclusion. The transportation interventions included one or more of the following: providing bus passes (n = 5), taxi/transport vouchers or reimbursement (n = 3), arranging or connecting participants to transportation (n = 2), and a free shuttle service (n = 1). Transportation support was offered within multi-component interventions including counseling, care coordination, education, financial incentives, motivational interviewing, and navigation assistance. Community health/outreach workers (n = 3), nurses (n = 3), and research or clinic staff (n = 3) were the most common interventionists. Studies reported improvements in cancer screening rates, chronic disease management, hospital utilization, linkage and follow up to care, and maternal empathy. Overall, transportation is a well-documented barrier to engaging in chronic care among vulnerable populations. We found evidence suggesting transportation services offered in combination with other tailored services improves patient health outcomes; however, future research is warranted to examine the separate impact of transportation interventions that are tested within multi-component studies.

Appendix 1: Complete Search Strategy

PubMed

January 5, 2018

146 results

((((((“Transportation of Patients“[Mesh:NoExp] OR “Transportation“[Mesh:NoExp] OR “Motor Vehicles“[Mesh:NoExp] OR “Automobiles“[Mesh] OR automobile* [tiab] OR autos [tiab] OR taxi [tiab] OR taxis [tiab] OR uber [tiab] OR lyft [tiab] OR “hired transportation” OR “public transportation” OR bus [tiab] OR busses [tiab] OR subway [tiab] OR “travel voucher” [tiab])))) AND (“Health Services Research“[Mesh] OR “Community-Based Participatory Research“[Mesh] OR “Nursing Research“[Mesh] OR “Clinical Trials as Topic“[Mesh] OR “Clinical Trial” [Publication Type] OR interven* [tiab] OR random* [tiab]) AND (“Health Services Administration“[Mesh] OR “Health Services“[Mesh] NOT “Emergency Medical Services“[Mesh]) AND ((((((((((“Diabetes Mellitus“[Mesh]) OR “HIV“[Mesh]) OR “Neoplasms“[Mesh]) OR “Cardiovascular Diseases“[Mesh]) OR “Hypertension“[Mesh]) OR “Dementia“[Mesh]) OR “Depressive Disorder“[Mesh]) OR “Arthritis“[Mesh]) OR “Osteoporosis, Postmenopausal“[Mesh]) OR “Pulmonary Disease, Chronic Obstructive“[Mesh] OR “Chronic Disease“[Mesh])

CINAHL Plus

January 5, 2018

175 results

Search ID#	Search terms	Search options	Number of items
S4	S1 AND S2 AND S3	Search modes—Boolean/Phrase	175
S3	MH diabetes mellitus OR MH osteoporosis OR MH chronic disease OR MH hiv OR MH hiv/aids OR MH neoplasm OR MH cardiovascular disease OR MH hypertension OR MH dementia OR MH depression OR MH arthritis OR MH chronic obstructive pulmonary disease	Search modes—Boolean/Phrase	259,866
S2	MH health services research OR MH community based participatory research OR MH nursing research OR MH clinical trials as topic OR MH clinical trials OR AB interven* OR AB random*	Search modes—Boolean/Phrase	515,457
S1	MH transportation OR MH patient transportation OR MH motor vehicle OR MH automobile OR TX taxi OR TX taxicab OR TX uber OR TX lyft OR TX travel voucher OR TX public transportation OR TX bus OR TX subway train	Search modes—Boolean/Phrase	23,433

Embase

January 5, 2018

161 results

• #5: AND #2 AND #3 AND #4

  161

• #4: ‘diabetes mellitus’/exp OR ‘human immunodeficiency virus infection’/exp OR ‘osteoporosis’/exp OR ‘chronic disease’/exp OR ‘neoplasm’/exp OR ‘cardiovascular disease’/exp OR ‘hypertension’/exp OR ‘dementia’/exp OR ‘depression’/exp OR ‘arthritis’/exp OR ‘chronic obstructive lung disease’/exp

  9,877,679

• #3: ‘health service’ OR ‘health care utilization’

  553,521

• #2: ‘health services research’ OR ‘participatory research’ OR ‘nursing research’ OR ‘clinical trial (topic)’ OR ‘clinical trial’ OR ‘intervention study’ OR ‘randomized controlled trial’

  1,720,531

• #1: ‘traffic’/exp AND ‘transport’/exp OR ‘patient transport’/exp OR ‘motor vehicle’/exp OR ‘car’/exp OR taxicab OR ‘subway’:ti,ab,kw OR (hired AND transportation) OR (travel AND voucher)