Limited Access to Systemic Lupus Erythematosus: A Systematic Review

Inequities in systemic lupus erythematosus (SLE) care affect outcomes (i.e., flares, damage, mortality), interventions (referrals, advanced therapies), and populations (gender, race/ethnicity, and geographic region). This systematic review highlights themes related to access to care for SLE patients and explores potential solutions to address these disparities.

In adherence to PRISMA guidelines, we conducted a systematic review of the literature. We searched for articles published in PubMed, Scopus, Web of Science, Cochrane Library, and EBSCO. Publications related to economic burden, barriers and facilitators to access, and potential solutions were included.

A total of 77 articles were identified. Five critical issues concerning access to SLE care were revealed from the literature: (1) economic burden, (2) barriers and facilitators to access, (3) utilization, (4) adherence, and (5) possible solutions to improve healthcare access.

The usual barriers and facilitators involved several social factors related to health (i.e., transportation, insurance, and limited access to mental health services, among others). Utilization of SLE care is influenced by socioeconomic status (SES), ethnicity, and education level. Factors like low education, low SES, rural residency, and depressive symptom adherence contribute to nonadherence. There were various proposals to improve access to SLE care, including peer support, digital platforms (e.g., telemedicine), and community-based programs (such as PALS and WELL).

The SLE care field highlights the inequalities that impact marginalized communities. Emphasizing community-based programs, addressing social determinants of health, acknowledging social exclusion, and adopting digital platforms can help reduce healthcare inequity.