Barriers to Accessing Urogynecologic Care: A Survey Study

Objectives: To determine what socioeconomic and demographic factors affect accessing initial care with a urogynecology provider and identify barriers to receiving adequate care, specifying what populations are being most affected, and in turn opportunities to enact targeted systemic change.

Methods: Inclusion criteria included new patients to urogynecology outpatient clinics at University Hospitals Cleveland Medical Center. Six urogynecology attending physicians were included in the study. A survey was created to glean demographic information and zipcodes. The zipcodes were used to assess area deprivation indexes (ADI) of participants utilizing Neighborhood Atlas® which accrued data from 2016 to 2021. ADI was divided into three brackets: 0-25 being the most affluent, 26-75, and 76-100 being the most disadvantaged. The survey included questions surrounding the number of providers told of symptoms prior to referral, time from referral to appointment, and barriers faced scheduling their first appointment with a urogynecologist. Surveys were distributed through RedCap online or on paper in waiting rooms. Fisher exact tests were used to determine significance between the ADI groups. Chart review was used to determine visit diagnoses.

Results: 59 women, mean age 57.4, were recruited. Patients were stratified by ADI with 9 patients in the 0-25 bracket, 40 patients in the 26-75 bracket, and 10 patients in the 76-100 bracket (Table 1). Of the 0-25 cohort, most presented with OAB/UUI (44.4%); appointment availability (66.7%) was the most common barrier; less than one month (55.6%) was the most common time from referral, and 1 provider told prior to referral (55.6%) was most common. Of the 26-75 cohort, most presented with OAB/UUI (37.5%); appointment availability (65%) was the most common barrier; less than one month (52.5%) was the most common time from referral, and 1 provider told prior to referral (62.5%) was most common. Lastly, the 76-100 cohort presented most with pelvic pain (60%); not knowing about the urogynecology specialty (50%) and appointment availability (40%) were the most common barriers; less than one month (80%) was the most common time from referral, and 2 providers told prior to referral (50%) was most common. Significant differences were seen for appointment availability (p: 0.005).

Conclusions: Stratification by ADI can elucidate barriers to healthcare and medical issues specific to the area. Primary diagnoses and barriers differed by ADI. Those in the most disadvantaged areas proportionally presented more commonly with pelvic pain, told more providers about symptoms prior to referral, and did not as frequently know about urogynecology as a specialty. Those in most affluent areas stated appointment availability being the most common barrier comparatively which was a significant difference between ADI cohorts. Further directions involve accruing more participants to achieve statistical significance and pursuing a national survey to glean data on how to improve access to care.