Structural Inequalities in Ambulatory Care: A Scoping Review of Access and Quality and the Neglected Dimension of Patient Safety.

(1)

Background

Ambulatory services are the main interface between populations and health systems, yet their benefits are unevenly distributed due to structural inequalities-systemic differences rooted in the social, economic, and political organisation of society. Inequities in access and quality are well documented, but patient safety remains the least examined. (2)

Methods

Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, PubMed/MEDLINE and Scopus were searched for studies published from 2010 to 2026. In total, 44 studies were included, predominantly from the USA (n = 31), and synthesised narratively. (3)

Results

Inequalities operated through geographic maldistribution, financial barriers, exclusionary institutional cultures, and market-driven practices. Access and quality were each addressed by 17 studies, whereas only four examined patient safety directly; the limited safety evidence indicated disproportionate diagnostic errors, medication-safety failures, and care-coordination breakdowns among vulnerable groups. Evidence was concentrated in the USA. (4)

Conclusions

Structural inequalities are well documented for access and quality but are markedly under-studied for patient safety-the principal evidence gap identified. Patient safety warrants treatment as an equity outcome, measured with stratification by structural disadvantage and addressed through system-level interventions.