Abstract 16947: Barriers to Care in Urban and Rural Dwelling Patients With Adult Congenital Heart Disease

Introduction: Adult congenital heart disease (ACHD) patients face a unique set of medical, psychological, and social challenges, and access to specialized ACHD care has been shown to improve their outcomes. Rural ACHD patients may represent a uniquely disadvantaged group given their complex health care needs and the distance they must travel to access care. The aim of this study was to investigate the challenges faced by ACHD patients in accessing outpatient cardiac care, with a specific focus on understanding barriers related to distance from care. Methods: This cross-sectional, survey-based study took place in the ACHD clinic at an academic medical center in a metropolitan area. Additional medical information was abstracted in a retrospective manner from the electronic health record. T-tests and Chi-square tests were used to investigate the relationship between variables. Results: A total of 100 patients participated in the study (mean age 40 ± 13 years, 60% female, 18% rural dwelling). The median driving distance to clinic was 20 miles (interquartile range 12 to 77 miles). The most commonly identified barriers to cardiac clinic visits were the financial losses related to taking time off from work (39%), distance of clinic from home (33%), and the weather (33%), whereas finding a ride to clinic, finding childcare, or the time of available clinic appointments were not perceived as significant barriers. As compared to urban dwelling patients, those who were rural dwelling had a lower level of education (p=0.04), more difficulty paying insurance premiums (p<0.001) and copays (p=0.005), and were more likely to identify the distance from clinic (p=0.05) and having to go into the city (p=0.02) as barriers to clinic appointments. Conclusions: Loss of compensation from taking time off work to attend a visit and distance to clinic were the most commonly identified barriers to outpatient cardiac care in this cohort of ACHD patients. These barriers, along with difficulty paying insurance premiums, are more common in rural dwelling patients. Initiatives such as telemedicine visits or providing financial subsidies for travel and treatment could help to expand specialty ACHD care and better serve this growing patient population.