Preference for In-Person Chaperone During Pelvic Exam Is Associated With Social Determinants of Health

Abstract

INTRODUCTION: Women’s healthcare requires awareness of how social determinants of health (SDH) impact patient safety and quality of care. Because of the effects of institutional racism and past discrimination, race is an important SDH in gynecology. In parallel with increased recognition of the importance of SDH, attention to measures of patient safety during clinical exams has heightened. While ACOG has long recognized the importance of providing an in-person chaperone during pelvic examinations for patients who prefer to have one, CMS only recently made provisions to cover the expense of an in-person chaperone. OBJECTIVE: To determine whether the desire for a chaperone during pelvic examination is associated with SDH in a large, transregional, and diverse university-based urogynecology practice. METHODS: After institutional leadership recognized the importance of offering patients in-person chaperones for pelvic examinations, our multisite, academic urogynecology practice modified its electronic intake questionnaire, accessed through the health system-wide electronic medical record. All patients were queried using the following item regarding preference for a chaperone during their pelvic examinations: “When you come into the office for an in-person visit and undergo a pelvic examination, would you prefer to have an extra person, or chaperone, present in the room?” This retrospective review of new patients to the practice from May 23 to July 17, 2024, evaluates the medical and demographic factors associated with an answer of “yes” to this question. Descriptive statistics are presented. Categorical data were compared using chi-square and Fisher exact tests as appropriate. All variables that were significant in univariate analysis were entered into a backwards logistic regression model. p<.05 was considered statistically significant. RESULTS: Of 401 new patients to the practice during the study period, 390 (97%) patients completed the intake question about chaperone preference. Their ages were (mean±SD) 58±16.6 years old with PFDI-20 scores of 82±52.2. The population self-identified as White (74%), Black (20%), other race (6%); 7.5% identified as Hispanic or Latino. See Table 1 for additional medical and demographic information. 74/390, 19.1%, indicated that they preferred to have a chaperone present during their pelvic examination. On univariate analysis, 14.6% of White patients compared to 27.4% of Black patients and 36.8% of other races (p=.007) preferred a chaperone. Similarly, non-Hispanic/Latino patients were less likely to prefer a chaperone than Hispanic/Latino patients (40% vs 16.2%, p=.014). More patients seeing a male than female physician (34.7% vs 16.7%, p=.005), and more patients with government insurance than private insurance (25.5% vs 14.6%, p=.009) desired a chaperone. On multivariable logistic regression, Black race (p=.028), Hispanic/Latino ethnicity (p=.017), and male physician gender (p=.004) remained independently associated with preference for a chaperone during pelvic exam. CONCLUSIONS: Women who identify as Black and/or Hispanic/Latino are more likely to prefer a chaperone during pelvic examinations than White, non-Hispanic women. As we identify resources to ensure patient safety with respect to SDH, it is essential to provide resources for in-person chaperones if desired by patients. More data is needed to drive efforts to promote equitable patient experiences in diverse clinical practices.