Investigating Disparities in Physical Therapy Utilization: An Intersectionality Perspective

Abstract

Objective

To investigate the role of race, ethnicity, language, insurance payor, and socioeconomic status, both individually and through an intersectional framework, on outpatient physical therapy (PT) utilization. A secondary aim was to examine the differences in scheduling and attendance based on the aforementioned factors.

Design

A retrospective cohort study examining outpatient PT referrals, scheduled appointments, and attendance. Data included the status of visit completion, race, ethnicity, language, insurance payor, and zip code. Multiple logistic regression models, with and without interaction terms, analyzed the association of demographic factors with outcomes of interest.

Setting

This retrospective cohort study collected data between July 2021 and July 2022 from electronic medical records within a large academic medical system in New England.

Participants

N=61,125.

Interventions

Not applicable.

Main Outcome Measures

This study assessed 3 outcomes. Outcome 1 analyzed the rates of scheduling after referral. Outcome 2 analyzed the rates of attendance after scheduling. Outcome 3 analyzed the rates of attendance after referral.

Results

Race, language, and income were associated with differences in scheduling versus attending PT. Black or African American patients showed the highest appointment-making rates and lowest attendance rates after scheduling compared with White patients. Asian patients demonstrated the lowest appointment-making rates and highest attendance rates after scheduling compared with White patients. Non-English-speaking patients were less likely to schedule and attend PT compared with English-speaking patients. Higher socioeconomic status was associated with higher rates of scheduling and attendance. Further disparities were noted when examining the interaction of variables. Increasing income benefited most, but not all groups. Black or African American patients experienced a decrease in scheduling and attendance rates with rising income compared with White patients. Non-English-speaking patients experienced less of an increase in scheduling and attendance rates with rising income compared with English-speaking patients.

Conclusions

Findings highlighted disparities in PT utilization in scheduling and attendance with regard to race, language, and income. Disparities were amplified when examining interactions between race and income and language and income, underscoring the importance of an intersectional analysis.