Patient Factors Associated with Access to Outpatient Pediatric General Surgical Care in a Rural State

Derek J Krinock; Esma Birisci; Deidre L Wyrick; Robert T Maxson; Melvin S Dassinger; Lindsey L Wolf

doi:10.1016/j.jpedsurg.2024.161899

Patient Factors Associated with Access to Outpatient Pediatric General Surgical Care in a Rural State

J Pediatr Surg. 2024 Sep 6:161899. doi: 10.1016/j.jpedsurg.2024.161899. Online ahead of print.

Authors

Derek J Krinock¹, Esma Birisci², Deidre L Wyrick³, Robert T Maxson³, Melvin S Dassinger³, Lindsey L Wolf³

Affiliations

¹ Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Electronic address: dkrinock@uams.edu.
² Department of Econometrics, Bursa Uludag University, Bursa, Turkey.
³ Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Division of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, AR, USA.

PMID: 39341779
DOI: 10.1016/j.jpedsurg.2024.161899

Abstract

Background: We sought to understand factors impacting timely access to outpatient pediatric general surgical care in a largely rural state.

Methods: We conducted a multi-site retrospective cohort study, evaluating patients <18 years referred for outpatient pediatric general surgical evaluation from 11/1/2017-7/31/2022. Outcomes included obtaining an appointment, completing an appointment, and undergoing an operation. Time to appointment and operation were calculated. Bivariate analysis and multivariable logistic regression were performed to evaluate for associations between patient factors and the primary outcomes, as well as delay to appointment.

Results: Of 5270 patients, mean age was 7.1 years (SD = 6) with 59% male. All patients obtained an appointment; 85% (n = 4498) completed an appointment within one year. Forty percent (n = 2092) underwent an operation. Mean times from referral to appointment and operation were 22.5 (SD = 33.4) and 81.5 days (SD = 137.5), respectively. Patients who identified as African American/Black (OR = 1.94, p < 0.001), had self-pay (OR = 6.33, p < 0.001), or lived >100 miles away (OR = 1.55, p < 0.001) were more likely to not complete appointments. Patients with high household income (OR = 0.70, p = 0.009) and private insurance (OR = 0.60, p < 0.001) were less likely to not complete appointments. Delay to appointment was associated with race (p = 0.020). Patients with private insurance (p < 0.001) and higher income (p = 0.020) were more likely to undergo operation.

Conclusion: Fifteen percent of patients referred for outpatient pediatric general surgical evaluation did not complete an appointment within one year. Race, household resources, insurance, and travel distance were associated with completing appointments. Information about groups that have disparate access to care will inform interventions to improve this access.

Type of study: Retrospective Cohort Study.

Level of evidence: III.

Keywords: Access to care; Delay to care; Health disparities; Outpatient pediatric surgery.