Do medicare patients with disabilities receive preventive services? A population-based study

Objective: To compare health maintenance procedure rates of Medicare patien ts with different levels of disability. Study Design: Observational study analyzing data from the 1995 Medicare Cur rent Beneficiary Survey (MCBS n = 15,590). Self-reported Pap smears, mammog rams, and influenza and pneumococcal vaccinations were compared between gro ups 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 less than or equal to 70, 23% vs 41%, p <.001) and mammograms (age greater than or e qual to 50, 13% vs 44%, p <.001). In a controlled analysis, individuals wit h 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 s mears and mammograms, respectively, compared with able-bodied women, regard less 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 rec eiving vaccinations. In general, patients in HMOs reported more procedures than those in fee-for-service, while those in long-term care facilities rep orted fewer procedures than those living in the community. Conclusions: Disability among Medicare patients is a significant, independe nt risk factor for not receiving mammograms and Pap smears. Efforts should be made to identify the most severely disabled because they are at particul ar risk. (C) 1999 by the American Congress of Rehabilitation Medicine and t he American Academy of Physical Medicine and Rehabilitation.