Exploring Patient Perceptions of Barriers to Urogynecologic Care

Objectives: To explore the patient experience and identify possible barriers to obtaining urogynecologic care in a diverse, urban setting

Methods: This is a qualitative study of adult female patients who received care at a large tertiary urban hospital in a diverse setting and were referred for, and subsequently missed, their new urogynecology or urodynamic testing appointment beginning in October 2022. Patients who spoke languages other than English or Spanish, had cognitive or verbal impairments that prevented them from completing a telephone questionnaire, or were unable to complete the telephone interview were excluded from participation. Demographic data including patient age, race, ethnicity, language, and insurance type were collected from the electronic medical record as well as patient-reported urogynecologic complaints resulting in their referral. A semi-structured interview guide was used to direct the phone interviews to qualifying patients after obtaining verbal consent. Interviews were completed by two researchers including one native Spanish-speaker. Conversations were recorded, de-identified, transcribed, and, if needed, translated by a bilingual researcher. Dedoose, an online program for qualitative research analysis, was used to code transcripts thematically and analyze them using grounded theory.

Results: Twelve participants were recruited and completed interviews. Participants were predominantly Hispanic (n=8). White (n=5), Black (n=1), Pacific Islander (n=1), and “not listed” (n=6) were the reported races (Table 1). The mean age was 56. The patients’ self-reported referral diagnoses included: incontinence (n=7), prolapse (n=3), recurrent urinary tract infection (n=1), voiding dysfunction other than incontinence (n=1), and lower abdominopelvic pain (n=1). Most patients had government-funded insurance (Medicaid, n=7; private insurance, n=2; self-pay, n=3).

All interviewed participants identified at least one barrier to accessing urogynecologic care. General themes of barriers to accessing urogynecologic care included perceived cost of appointment, transportation, location of clinical encounter, scheduling conflicts, and patient or family member illness. Scheduling conflicts related to poor communication from clinic staff was the most common reason reported. Transportation was the second most cited barrier, with cost and reliance on others appearing as common subcategories. Most patients reported persistent symptoms while awaiting urogynecologic evaluation.

Conclusions: Barriers to accessing urogynecologic care are prevalent, even in a large, high-resource health center. This study adds to the current literature as it involves analyses of themes in both English and Spanish-speaking patients in a diverse location that closely mirrors the sociodemographic make-up of the United States. All participating patients reported at least one barrier to accessing care, with scheduling conflicts and transportation being the most common reasons for missed new patient or urodynamic appointments. It is imperative that providers advocate for expanded access and aim to implement policy changes to address these inequalities in urogynecologic care.