S. Bazikian2, B. Deras-Guerra2, S. Schepens Niemiec3, K. Gonzalez4, C. Lynch4, S. Han1, D. Armstrong1, T. Tan1 1University Of Southern California, Division Of Vascular Surgery And Endovascular Therapy, Los Angeles, CA, USA 2University Of Southern California, Keck School Of Medicine, Los Angeles, CA, USA 3University Of Southern California, Division Of Occupational Therapy And Occupational Science, Los Angeles, CA, USA 4Los Angeles General Medical Center, Los Angeles, CA, USA
Introduction:
Despite ongoing efforts in limb salvage care, racial, ethnic, and socioeconomic disparities in diabetes-related amputation rates persist. These disparities are complex and may be related to health care barriers due to adverse social and economic factors. The objective of the study was to determine the reasons associated with difficulties in accessing medical care among patients with a new diabetic foot ulcer (DFU).
Methods:
This prospective observational study enrolled adults aged 18 years or older with a new DFU (less than 6 months) who presented to two safety-net hospitals in Southern Arizona and Southern California between December 2019 to December 2022. The primary outcome was the patient’s survey response on difficulty in accessing medical care, further categorized into reasons related to transportation, finances, employment, and caregiving. We used multivariable logistic models to analyze the association between sociodemographic factors and the primary outcome. Odds ratios (ORs) with a 95% Confidence Interval (CI) were reported.
Results:
Among the 178 patients with 205 new DFU included in the study, 33% were female, 64% were adults identified as Hispanic, Native American, or multiracial, 66% were Medicaid or Indian Health Services beneficiaries, and 51% lived in zip codes within the highest quintile of the Social Deprivation Index. Of the patients with DFUs, 43% reported challenges in accessing medical care. These challenges were primarily linked to transportation (73%), financial difficulties (56%), job-related issues (37%), and caregiving responsibilities (28%). In univariate analysis, patients reporting difficulty in obtaining medical care were more likely to undergo major or minor amputation (p<.05), although there was no difference in ulcer healing rates. Multivariate analysis showed that females (OR: 2.41, CI 95%. p<.05) and Hispanic individuals were more likely to report experiencing difficulties accessing medical care (OR: 1.98, CI 95%, p<.05). Patients diagnosed during an emergency room visit or hospital visit also reported more difficulties with accessing medical care (OR: 2.45, CI 95%, p<.01) than those who were diagnosed during an outpatient visit. Notably, Medicare beneficiaries were more likely to experience difficulties than those with commercial insurance (OR: 2.82, CI 95%, p<.05).
Conclusion:
Patients with DFUs at two safety-net hospitals reported a 43% rate of difficulty accessing medical care, especially related to transportation and finances. Hispanic adults, women, and those diagnosed during an emergency visit or hospitalization were associated with greater care access issues. These data highlight the challenges in accessing limb preservation care and provide areas to specifically target for improvement.