Do Medicare patients with disabilities receive preventive services? A population-based study.
OBJECTIVE
To compare health maintenance procedure rates of Medicare patients with different levels of disability.


METHODS
Observational study analyzing data from the 1995 Medicare Current Beneficiary Survey (MCBS, n = 15,590). Self-reported Pap smears, mammograms, and influenza and pneumococcal vaccinations were compared between groups with different levels of health-related difficulties in six activities of daily living (ADL).


RESULTS
Compared to those without disabilities, the most severely disabled women (limitations in 5 or 6 ADL) reported fewer Pap smears (age < or =70, 23% vs 41%, p < .001) and mammograms (age > or = 50, 13% vs 44%, p < .001). In a controlled analysis, individuals with this high level of disability were 57% (95% confidence interval [CI], 33% to 72%) and 56% (95% CI, 43% to 76%) less likely to report receiving Pap smears and mammograms, respectively, compared with able-bodied women, regardless of their age, whether they were in an HMO, or whether they lived in a long-term care facility. Functional limitations were not a deterrent to receiving vaccinations. In general, patients in HMOs reported more procedures than those in fee-for-service, while those in long-term care facilities reported fewer procedures than those living in the community.


CONCLUSIONS
Disability among Medicare patients is a significant, independent risk factor for not receiving mammograms and Pap smears. Efforts should be made to identify the most severely disabled because they are at particular risk.
Chan
L
L
Department of Rehabilitation Medicine, University of Washington, Health Care Financing Administration, Seattle 98121, USA.
Doctor
J N
JN
MacLehose
R F
RF
Lawson
H
H
Rosenblatt
R A
RA
Baldwin
L M
LM
Jha
A
A
D001428:Bacterial Vaccines; D006233:Persons with Disabilities; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D007252:Influenza Vaccines; D008327:Mammography / Q000706:statistics & numerical data; D006278:Medicare; D065006:Papanicolaou Test; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D013296:Streptococcus pneumoniae / Q000276:immunology; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data; D014626:Vaginal Smears / Q000706:statistics & numerical data
D001428:Bacterial Vaccines; D007252:Influenza Vaccines