Patterns of ambulatory care use for gynecologic conditions in the United States

Abstract

Objective: To describe ambulatory care visits for gynecologic disorders in the United States and to determine what patient factors best predict the site of care for these conditions: private physician offices, hospital outpatient departments, or emergency departments (EDs).Methods: Cross-sectional analysis of combined data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey for 1995–1996 was conducted. Visits were selected if the principal diagnosis was consistent with one of 10 gynecologic categories. Descriptive analysis was performed using χ2. Logistic regression was used to determine patient factors that best predicted ED and hospital outpatient department visits.Results: There were 23,194,000 ambulatory care visits for chronic gynecologic conditions during the 2-year study period. Menopause was the most common condition encountered at physician offices. Lower genital tract infections were the most common diagnosis at EDs. Medicaid coverage, self-pay status, median household income of $20–29K, and patient race were significantly predictive of ED visits, after adjustment for the principal gynecologic diagnosis. HMO coverage was associated with a 50% reduction in ED use.Conclusions: Patient race, expected source of payment, and median income are significant predictors of ED visits, independent of the specific gynecologic diagnosis. Health policy makers must consider economic factors as well as gynecologic disease in making decisions regarding women’s health care.