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Women's Health

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Disabled women who have difficulty walking are less likely than other women to receive Pap smears and mammograms

Nearly one in five women living in the community has at least one potentially disabling condition, the most common being problems with lower extremity mobility (12 percent). Disabled women with conditions ranging from blindness and deafness to upper extremity mobility and mental health problems have rates of screening and preventive services comparable to nondisabled women with similar health insurance and sources of care. However, women with lower extremity mobility difficulties are significantly less likely than other women to receive screening and preventive services.

Efforts should be made to extend these screening services to disabled women, who often live normal life spans, recommends Lisa I. Iezzoni, M.D., M.Sc., of Harvard Medical School. With support from the Agency for Healthcare Research and Quality (HS10223), Dr. Iezzoni and her colleagues used data from the 1994-1995 National Health Interview Survey, with Disability, Family Resources, and Healthy People 2000 supplements, to examine use of screening and preventive services among adult women with disabilities living in the community.

After adjusting for sociodemographic and access characteristics, women with major, lower extremity difficulties were much less likely than other women to receive Pap smears, mammograms, and clinician inquiries about smoking. Inaccessible examination tables present particular problems for these disabled women, and doctors sometimes don't examine them fully because of concerns about positioning them on the table. Motorized tables that can be lowered for easy transfers from chairs or wheelchairs could make it easier for doctors to provide Pap smears to these women, but access to mammography may be more difficult to arrange for women in wheelchairs. Other barriers to improved screening for these women may be inadequate knowledge or biased attitudes of clinicians regarding their sexuality, as well as time pressures in busy practices.

More details are in "Use of screening and preventive services among women with disabilities," by Dr. Iezzoni, Ellen P. McCarthy, Ph.D., Roger B. Davis, Sc.D., and others, in the July 2001 American Journal of Medical Quality 16(4), pp. 135-144.

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