The Effect of Health Access Inequity on Emergency Department Visits of Women With Gynecologic Complaints [15Q]

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Abstract

INTRODUCTION:

Health access disparities affect health outcomes. Lack of access to routine health care may result in the overuse of the emergency department (ED). Our objective is to examine whether disparities influence the type, severity and treatment of gynecologic diseases seen in the ED.

METHODS:

We conducted a retrospective chart review of all consecutive gynecologic ED consults between July 2011–March 2012 at a large academic public city hospital and at its sister private tertiary teaching hospital. Pregnancies greater than 16 weeks were excluded. Demographic and clinical information were collected.

RESULTS:

A total of 909 and 960 ED visits from the public and private hospital, respectively, were eligible. Public hospital patients were more often younger and non-Caucasian (P<.001). Public hospital patients were more likely to be uninsured (38.2% vs 4.7%, P<.001), to report no access to a PCP (23% vs 8.6%, P<.001), and to be anemic (mean hematocrit 35.5±4.9 vs 37.29±5.0, P<.001). The leading reason for ED visits in both institutions was early pregnancy-related complaints (51.7% vs 31.4%, P<.001). Benign uterine pathology and gynecologic malignancy were the most common reasons for admission in public and private hospital (24% vs 17%). Patient insurance status was not associated with severity of disease at time of admission (10.2% vs 11.7%, P>.05).

CONCLUSION:

Early pregnancy remained the leading reason for ED visits in both hospitals. Increasing access to early prenatal care may reduce ED visits. Health access inequity appeared not to influence severity of disease at hospital admission.

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