Barriers to accessing urogynecologic care in a federally qualified health center

Abstract

Importance: Social and structural barriers affect access to urogynecologic care for underserved patients, but few studies explore patient experiences at federally qualified health centers (FQHCs).

Objective: The objective of this study was to identify barriers to accessing urogynecologic care from the patient perspective at an FQHC affiliated with an academic medical center.

Study design: Female-identifying patients ages 18-100 years who were referred for and subsequently missed their new urogynecology appointment from October 1, 2022, through February 28, 2023, were recruited for participation in qualitative interviews. A semi-structured interview guide was used for telephone interviews. Transcripts were coded thematically using grounded theory until theoretical saturation was reached.

Results: Thematic saturation occurred with 17 participants. Participants were predominantly Hispanic, the mean age was 55 years, and most were insured by Medicaid or self-pay. The most common referral diagnosis was urinary incontinence (n=13). Major themes regarding barriers included scheduling issues, transportation, language barriers, and perceived costs. All participants identified at least 1 barrier to accessing urogynecologic care, with scheduling challenges related to poor communication from clinic staff as the most common reason. Transportation was the second most cited barrier.

Conclusions: Barriers to accessing urogynecology care are prevalent, even at FQHCs with dedicated subspecialists on site. Poor communication and transportation were the most cited barriers. These findings can inform quality improvement projects to increase access to urogynecologic care in these settings. It is imperative that women's health providers advocate for expanded access and implement changes to address these inequalities in urogynecologic care.