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Patients with disabilities are less likely than nondisabled patients to receive preventive care services

More than one out of five people older than 65 has some sort of disability. As the U.S. population continues to age, more Medicare patients will be disabled. Unfortunately, severely disabled Medicare patients are less apt to receive needed preventive services than their nondisabled counterparts, according to a study supported in part by the Agency for Health Care Policy and Research (contract 290-93-0036).

The study found that the most severely disabled Medicare-insured women (limited in their ability to carry out five or six activities of daily living) who were 70 years of age or younger reported fewer Pap smears (23 percent vs. 41 percent) and those age 50 and older reported fewer mammograms (13 percent vs. 44 percent) compared with similar nondisabled women. These rates decreased even further to 9.3 percent for Pap smears and 5.3 percent for mammograms for severely disabled women living in long-term care facilities.

Efforts should be made to identify patients who are severely disabled—especially those in long-term care facilities—because they seem to be particularly vulnerable, suggest the Seattle, WA, researchers who conducted the study. They analyzed data from the 1995 Medicare Current Beneficiary Survey to calculate self-reported Pap smears, mammograms, and influenza and pneumococcal vaccinations among groups with different levels of disability (number of limitations in daily living activities).

In a controlled analysis, severely disabled women were about 56 percent less likely to report receiving Pap smears and mammograms, compared with nondisabled women, regardless of age, health maintenance organization (HMO) enrollment status, or long-term care arrangements. However, functional limitations were not a deterrent to receiving the vaccinations studied. It may be more difficult to perform a mammogram or Pap smear on a woman who has functional limitations, especially if she has impaired mobility. Also, disabled individuals are apt to have multiple medical problems, and physicians may concentrate on these issues and neglect health maintenance items. On the other hand, providers may believe that preventive services are less important or cost effective for seriously disabled individuals, whose quality of life may already be low.

More details are in "Do Medicare patients with disabilities receive preventive services? A population-based study," by Leighton Chan, M.D., Jason N. Doctor, Ph.D., Richard F. MacLehose, M.S., and others, in the June 1999 Archives of Physical Medicine and Rehabilitation 80, pp. 642-646.

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