(13) Addressing an Unmet Need in Pediatric and Adolescent Gynecology (PAG) Specialty Care in Northern New England: Demographics of and Distance Traveled to Newly Established PAG Clinic

Background: With the introduction of The American Board of Obstetrics and Gynecology’s Focused Practice Designation pathway in Pediatric and Adolescent Gynecology (PAG), Dartmouth Hitchcock Medical Center (DHMC) started a PAG clinic in 2018. Prior to this time, there was no PAG provider in New Hampshire (NH) and thus no provider serving the broad catchment area of this rural tertiary care center. We hypothesized this care deficit led to geographic disparities in gynecologic and reproductive health care for this population. The objective of this study is to describe the patient population and their distance traveled since inception of the clinic.

Methods: This is an IRB-exempt, retrospective chart review of non-pregnant females, less than 18 years of age, seen by the PAG provider at DHMC’s OBGYN clinic from 1/2018 through 3/2023. Demographic characteristics, as well as past medical history, source of referral to the clinic, and visit diagnoses were extracted. Distance traveled (DT) was defined as patients’ one-way travel from home address, or PO Box, to DHMC in miles.

Results: An EPIC query resulted in 954 MRNs; 153 charts have been reviewed to date and 55 met inclusion criteria. 56.4% were residents of NH and 43.6% of Vermont. The mean age at first visit was 12.75 years (range 1 month-17 years). The mean DT was 43 (range 2.90 to 122; median 31.90) (Figure 1). For patients less than 10 years, mean DT was 78.79; for those 10 years or older, the mean was 33.01. For patients with subsequent visits, those with a DT of less than 80, the rate of telehealth was 24.2% and for those with a DT greater than or equal to 80, the rate of telehealth was 75%. Those with DT over 80 were more likely to have public insurance (77.8%) than private (22.2%), compared to those with DT less than 80 (public 21.7%, private 73.9%). The top three visit diagnoses for those with DT less than 80 were menstrual management (45.7%), abnormal uterine bleeding (34.8%), and LARC placement for menstrual management/dysmenorrhea (19.6%). For those with DT more than or equal to 80, three diagnoses tied for the most common at 22.2%: menstrual management, hymenal variants, and ovarian cysts.

Conclusions: This is the first study to describe the PAG patient population seen at a rural tertiary care center, providing specialty services to patients largely in Northern New England. Patients seen were aged 1 month to 17 years and had a DT of 3 to 122 for PAG specialty care. Patients 10 years and younger traveled further than older patients. Most common visit diagnoses differed for those who had a DT over 80.