Barriers to Accessing Urogynecologic Care: A Single-Site Survey Study

Disparities in urogynecologic care are well documented, but patient-reported barriers remain poorly characterized.

The objective of this study was to evaluate how structural and informational barriers to urogynecologic care vary by race and neighborhood socioeconomic disadvantage, measured using the Area Deprivation Index (ADI).

This cross-sectional study surveyed new urogynecology patients at a midwest academic medical center between January 2024 and May 2024 (IRB STUDY20231132). Participants completed a 23-item questionnaire adapted from the National Institutes of Health All of Us survey assessing access, symptom recognition, referral pathways, and perceived barriers. Demographic and clinical data were obtained by chart review. Zip code-linked ADI percentiles were analyzed using nonparametric tests and multivariable logistic regression, with ADI reported per 10-point increase.

Among 219 participants, Black patients resided in more disadvantaged neighborhoods than White patients (mean ADI 80.0 vs 53.4; P<0.001). Higher ADI was independently associated with ≥1-hour round-trip travel (odds ratio [OR], 1.42; 95% CI, 1.15-1.79; P<0.001) and seeing ≥2 health care providers before referral (OR, 1.17; 95% CI, 1.03-1.35; P=0.020). The Black race was independently associated with reporting multiple barriers (OR, 4.79; 95% CI, 1.76-13.19; P=0.002) and time off work as a barrier (OR, 4.42; 95% CI, 1.24-15.3; P=0.023). Higher ADI was also associated with a lack of awareness of urogynecology (OR, 1.27; 95% CI, 1.04-1.59; P=0.020). Appointment wait time ≥1 month was not associated with ADI or race.

Race and neighborhood disadvantage were independently associated with distinct barriers to urogynecologic care, supporting targeted, equity-focused interventions. The authors encourage institutions to assess barriers faced by their community patient populations.