Do Women Normalize Urinary Incontinence? Factors Associated With Self-Referral Versus Provider Referral to Urogynecology

INTRODUCTION: The option for self-referral to urogynecology provides an important avenue to access care. Increasingly, patients are pursuing self-referral; however, little is known about the self-referred population compared with those referred. OBJECTIVE: This study sought to characterize the self-referred and provider referred patient populations presenting to urogynecology, to identify factors associated with self-referral. METHODS: We conducted a retrospective chart review of individuals aged ≥18 years that presented as new patients to the Division of Urogynecology. Charts were screened to reach 2200 subjects, inclusive of all new patient visits from 3/2023 to 12/2024. We abstracted data on referral status, age, race/ethnicity, insurance, language, if pregnant or postpartum, and primary diagnosis. The 9-digit zip code was used to determine the area deprivation index (ADI) state and national rankings. Cohorts were defined by referral status, comparing self-referred versus provider-referred subjects. Our primary objective was to assess demographic and clinical factors associated with self-referral. RESULTS: A total of 2200 subjects were included, with 753 (34.2%) self-referred and 1447 (65.8%) provider referred. The majority were non-Hispanic white (57.7%), English-speaking (93.5%), privately insured (59.2%), and represented the least disadvantaged neighborhoods based on ADI for state (63.1%) and national (85.9%) rankings. The most common primary diagnoses included: urinary incontinence [UI] (49.9%), pelvic organ prolapse [POP] (17.7%), urinary tract infections [UTIs] (13.5%), and pain conditions (9.2%). Self-referred subjects were more likely to be non-Hispanic white (61.6% vs 55.6%, p=0.006), English speaking (95.6% vs 92.3%, p=0.011), and have a diagnosis of POP (20.1% vs 16.5%, p<0.001), UTIs (17.3% vs 11.5%, p<0.001), or pain conditions (11.7% vs 8.0%, p<0.001). Those less likely to be self-referred had a primary diagnosis of UI (41.6% vs 54.3%, p<0.001), were pregnant (0.3% vs 1.6%, p=0.005), or were postpartum (2.8% vs 8.6%, p<0.001). There were no differences in ADI rankings between groups. Noting the differences in primary diagnosis between the self-referred and provider-referred populations, we also evaluated the likelihood of self-referral by diagnosis. Of the total subjects presenting with UI, only 28.5% were self-referred, compared with POP (38.8%), UTIs (43.9%), and pain conditions (43.3%). Controlling for race/ethnicity, insurance type, language, pregnant or postpartum, and primary diagnosis, the following remained associated with self-referral status: non-English primary language (aOR 0.57, 95% CI 0.370, 0.893, p=0.014), pregnant or postpartum (aOR 0.23, 95% CI 0.146, 0.372, p<0.001), and primary diagnosis of POP (aOR 1.75, 95% CI 1.361, 2.244, p<0.001), UTIs (aOR 1.89, 95% CI 1.444, 2.473, p<0.001), or pain conditions (aOR 2.02, 95% CI 1.469, 2.778, p<0.001), with UI as the reference. CONCLUSIONS: A significant proportion of new patients presenting to urogynecology represent self-referrals. Aside from primary language, demographic factors were not associated with referral status. While urinary incontinence represented the most common reason for urogynecologic evaluation among provider-referred and self-referred individuals, patients were comparatively less likely to identify this as a reason for self-referral. Our results suggest a possible benefit to targeted patient outreach related to urinary incontinence. Given existing barriers to care, opportunities to increase self-referrals to urogynecology may enhance access.