Navigating the Threshold: Barriers and Facilitators to Accessing Primary Care Among People Living with Dementia-A...

Dementia is a global health priority affecting more than 55 million people worldwide, with projections indicating this figure will rise to 139 million by 2050. People living with dementia (PLWD) face profound difficulties accessing primary care services-the critical gateway to dementia diagnosis, ongoing management, and coordinated specialist referral. Despite growing evidence on individual barriers, a comprehensive synthesis integrating patient, caregiver, and system-level perspectives is lacking.

This systematic review and meta-synthesis aimed to identify, appraise, and synthesize evidence on the barriers and facilitators experienced by PLWD and their caregivers when accessing primary care services, and to propose evidence-based recommendations to address inequities.

A systematic search was conducted to identify relevant articles in six electronic databases: PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Web of Science from January 2000 to December 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Qualitative, quantitative, and mixed-methods studies reporting barriers or facilitators to primary care access for PLWD were included. A convergent integrated synthesis and thematic meta-synthesis approach was applied. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT).

Forty-three studies from 18 countries met inclusion criteria. Barriers were categorized across five domains: (1) patient-level factors (stigma, denial, symptom normalization, and limited health literacy); (2) caregiver-level factors (burden, late symptom recognition, and cultural barriers); (3) provider-level factors (insufficient training, therapeutic nihilism, and time constraints); (4) system-level factors (fragmented care pathways, long waiting times, and poor care coordination); and (5) structural and societal factors (rurality, poverty, and ethnic minority status). Facilitators included caregiver advocacy, strong patient-GP relationships, dementia literacy campaigns, availability of memory clinics, and integrated care models. Disparities were consistently greater for ethnic minority groups, rural populations, and those with lower socioeconomic status.

Barriers to primary care access in dementia are complex, overlapping, and mutually reinforcing. Effective strategies require multi-level interventions addressing individual, relational, provider, and system dimensions simultaneously.