title: Do Medicare patients with disabilities receive preventive services? A population-based study.
abstract: 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.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Health Care Financing Administration, Seattle 98121, USA.
authors.forename: L
authors.initials: L
authors.lastname: Chan
authors.forename: J N
authors.initials: JN
authors.lastname: Doctor
authors.forename: R F
authors.initials: RF
authors.lastname: MacLehose
authors.forename: H
authors.initials: H
authors.lastname: Lawson
authors.forename: R A
authors.initials: RA
authors.lastname: Rosenblatt
authors.forename: L M
authors.initials: LM
authors.lastname: Baldwin
authors.forename: A
authors.initials: A
authors.lastname: Jha
mesh_terms: 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
chemical_list: D001428:Bacterial Vaccines; D007252:Influenza Vaccines