Disability and receipt of clinical preventive services among women

Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey 08854, USA.
Women s Health Issues (Impact Factor: 1.61). 11/2006; 16(6):286-96. DOI: 10.1016/j.whi.2006.09.002
Source: PubMed

ABSTRACT More individuals are surviving catastrophic injuries and living longer with persistent disability; however, their receipt of clinical preventive services is not well understood as compared with those without disabilities given the dual focus of care on both primary prevention and the prevention of secondary complications related to their disabilities.
Longitudinal analyses of 1999-2002 Medical Expenditure Survey (MEPS). Study sample consisted of 3,183 community-dwelling women aged 51-64 years and followed for 2 full years. Women with disabilities were defined as having reported any limitation in any area of activity of daily living in 2 years. Recommended clinical preventive services were defined as receiving the following at the recommended intervals: colorectal, cervical, and breast cancer; cholesterol screening; and influenza immunization. chi(2) tests and multiple logistic regressions were used to examine variations in use of clinical preventive services.
Overall, 23% of the women in the study (n = 835) were disabled. Disabled women, however, were less likely to receive mammography and Pap smears within the recommended intervals. However, disabled women were more likely to receive influenza immunization, cholesterol screening, and colorectal screening within the recommended intervals. Among the disabled, usual source of care and health insurance remained significant predictors of receipt of clinical preventive services across all types,
Disabled women were less likely to receive some of the cancer screening services, suggesting a need for targeted interventions to promote breast cancer and cervical cancer screening. Increased access to health care insurance and health care providers may also help.

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Available from: Wenhui Wei, Aug 15, 2015
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    • "Health disparities for intellectual and developmental disabilities (I/DD) often exist, including poorer health, unmet health needs, and problematic access to primary and preventive health services [1] [2] [3] [4] [5] [6] including preventive oral health services and severe oral health disparities. The safety net to offset these disparities in oral health is lacking in a comprehensive system of care [7]. "
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    ABSTRACT: Access to oral health care is essential for promoting and maintaining overall health and well-being, yet oral health disparities exist among vulnerable and underserved populations. While nurses make up the largest portion of the health care work force, educational preparation to address oral health needs of elders and persons with disabilities is limited across nursing curricula. This descriptive study reports on the interdisciplinary development, implementation, and testing of an oral health module that was included and infused into a graduate nursing curriculum in a three-phase plan. Phase 1 includes evaluation of a lecture presented to eight gerontological nurse practitioner (GNP) students. Phase 2 includes evaluation of GNP students' perceptions of learning, skills, and confidence following a one-time 8-hour practicum infused into 80 required practicum hours. The evaluation data show promise in preparing nurse practitioner students to assess and address preventive oral health needs of persons aging with disabilities such that further infusion and inclusion in a course for nurse practitioners across five specialties will implemented and tested in Phase 3.
    04/2012; 2012:157874. DOI:10.1155/2012/157874
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    • "Intrapersonal factors include barriers to communication with clinicians or clinic staff and insufficient clinician knowledge about disabilities (Nosek et al., 1995). Environmental factors that influence receipt of CPS by WWD include transportation, health insurance coverage, and accommodation in the health care setting (Mele, Archer, & Pusch, 2005; Nosek et al., 1995; Scheer, Kroll, Neri, & Beatty, 2003; Smeltzer, 2006; Wei et al., 2006). Many physicians' offices are not equipped with scales accessible to people with disabilities, especially wheelchair users (Graham & Mann, 2008). "
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    ABSTRACT: This article describes the development of Promoting Access to Health Services (PATHS), an intervention to promote regular use of clinical preventive services by women with physical disabilities. The intervention was developed using intervention mapping (IM), a theory-based logical process that incorporates the six steps of assessment of need, preparation of matrices, selection of theoretical methods and strategies, program design, program implementation, and evaluation. The development process used methods and strategies aligned with the social cognitive theory and the health belief model. PATHS was adapted from the workbook Making Preventive Health Care Work for You, developed by a disability advocate, and was informed by participant input at five points: at inception through consultation by the workbook author, in conceptualization through a town hall meeting, in pilot testing with feedback, in revision of the curriculum through an advisory group, and in implementation by trainers with disabilities. The resulting PATHS program is a 90-min participatory small-group workshop, followed by structured telephone support for 6 months.
    Health Promotion Practice 11/2010; 13(1):106-15. DOI:10.1177/1524839910382624 · 0.55 Impact Factor
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    • "Most findings relating to mammography and breast cancer care disparities come from large population-based surveys or cancer registry data, without sufficient detail to identify specific causes(Chan et al., 1999; Chevarley et al., 2006; Iezzoni et al., 2000; Iezzoni et al., 2001; Iezzoni et al., 2008; McCarthy, Ngo, Roetzheim, Chirikos, Li, Drews, & Iezzoni, 2006a; Wei et al., 2006). To explore how physical access affects breast cancer diagnosis and treatment experiences, we conducted in-depth, individual interviews with 20 women with chronic mobility impairments who developed early stage breast cancer. "
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    ABSTRACT: To explore the perceptions of patients with breast cancer with mobility impairments of the physical accessibility of healthcare facilities and equipment. Individual audiotaped interviews lasting one to two hours. Interviews in homes or workplaces or by telephone. 20 women with chronic mobility impairments who developed early-stage breast cancer prior to age 60. Three were recruited from oncologist panels and 17 from informal social networks of disabled women nationwide. Qualitative analyses of interview transcripts to identify common themes. Extent and nature of mobility impairments and concerns raised by patients about barriers to care. The 20 participants identified issues with inaccessible equipment, including mammography machines, examining tables, and weight scales. The patients sometimes needed to insist on being transferred to an examining table when physicians preferred to examine them seated in their wheelchairs. When staff would transfer them, patients feared injury or felt badly when clinical personnel were injured during transfers. Other issues included difficulties with positioning and handling patients' uncontrollable movements. Even when clinical sites had accessible equipment, this equipment was sometimes unavailable for the appointment. Women with major mobility issues who developed breast cancer confronted numerous physical barriers during the course of their breast cancer diagnosis and treatment. With the aging of the baby boomer generation, an increasing number of people with mobility impairments will be seeking healthcare services. Healthcare providers should be proactive in planning to accommodate these patients by considering accessibility whenever they acquire new equipment, renovate older structures, or build new facilities. They also should establish policies and procedures to ensure that equipment is available during appointments of patients with mobility issues and that staff are trained in safe transferring procedures. Ensuring accommodations and accessibility will benefit patients with impaired mobility and clinical staff.
    Oncology Nursing Forum 11/2010; 37(6):711-7. DOI:10.1188/10.ONF.711-717 · 1.91 Impact Factor
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