Dr. Amanda Williams is a 2020–2021 Doximity Research Review Fellow. Nothing in this article is intended nor implied to constitute professional medical advice or endorsement. The views expressed in this article are those of the author and do not necessarily reflect the views/position of Doximity.
A recent publication by Fortin et al. noted a progressive increase in ED visits for patients with a primary diagnosis of leiomyomas. The study looked at information from 2006 to 2017 from a database of over 900 hospitals across the country. During this time, the admission rate for these patients decreased from 23.9% to 11.1%, despite the fact that the overall admission rate for all other primary diagnoses remained relatively stable. Bleeding-related complaints were associated with an increased likelihood of admission. Fortin et al. suggest that the increase in ED utilization for leiomyomas, combined with the decrease in hospital admissions, warrants further examination.
A combination of factors likely influenced the results of Fortin’s study, including increased numbers of patients receiving treatment in the ED (versus on the hospital floor) and decreased access to outpatient care. Additionally, the patients included in the study were most likely to be in the lowest income quartile and least likely to be in the highest income quartile, which is consistent with prior work showing increased ED use for gynecologic conditions in patients with lower incomes.
As clinicians, we must strive to understand the reasons underlying ED visits for non-admitted patients with leiomyomas. Improvements in access to outpatient gynecologic care could ameliorate ED utilization for non-urgent issues while also potentially improving patient experiences of care and preventing serious future complications, including those resulting from worsening bleeding related to leiomyomas. Given recent delays in primary and specialty care related to the COVID-19 pandemic, this issue is likely even more critical as we proceed into the future.
Dr. Williams completed her undergraduate training at the University of Notre Dame in 2013 after majoring in physics. She then went on to medical school in Chicago and is now in her final year of ob/gyn residency in Houston, Texas.