Women's choice of strategies for improving utilization of HIV/AIDS screening services

Our purpose in the study was to examine women's choice of strategies for improving utilization of HIV/AIDS screening. A-26-item questionnaire was used to gather data from a purposive sample of 1,052 women seeking care in three government hospitals in Akwa Ibom State, Nigeria. Findings revealed that the strategies mostly accepted in order included the following: providing awareness on screening services; routine health education on screening services in health facilities and community; and integrating screening advocacy in all educational curricula. Chi-square analysis revealed that age and marital status significantly influenced women's choice of the strategies. The strategies were recommended for adoption in HIV/AIDS prevention programs in the state.

Abuse and psychosocial stress as factors in high utilization of medical services during pregnancy

High utilization of medical services during pregnancy has not been described as most studies have focused on women who receive inadequate or no prenatal care. This paper describes the characteristics and medical utilization data of 500 pregnant women enrolled in a prospective study. High utilizers (HU), who had a mean of 7.8 utilizations (SD = 3.2), were significantly more likely to be nonwhite, low income, and younger than low utilizers (LU) who had a mean of 0.99 utilizations (SD = 1.1). HU reported a 32% rate of recent abuse compared to 9% for LU. HU also reported significantly more stress, lower self-esteem, and more ambivalence about the pregnancy. Consistent with their higher utilization, they were more likely to be diagnosed with preterm labor, hyperemesis, and gestational diabetes. HU had a higher proportion of complaints of nausea, vomiting, diarrhea, and pain and more mental health diagnoses than LU. Overall, HU were a vulnerable group characterized by recent abuse, economic disadvantage, psychosocial stress, and mental health issues. Their high utilization of medical services may have been due in large part to unmet psychosocial needs.

Association of contextual factors and breast cancer screening: finding new targets to promote early detection

BACKGROUND

Disparities in breast cancer screening (BCS) exist within the United States. Although such factors as a woman's income and insurance status explain some differences, additional contributions related to local healthcare system characteristics or the social and economic context in which women live have not been fully explored.

METHODS

Using data from a cross-sectional survey of Ohio residents, we assessed BCS in a state-representative sample of 2231 women between the ages of 50 and 69 years. Urbanization, the proportion of female-headed households (FHH), managed care activity, the number of primary care physicians (PCPs) per capita, and county designation as being medically underserved represented some of the contextual characteristics we examined. Using nested hierarchical logistic regression models, we evaluated the association of these characteristics with BCS before and after adjusting for respondents' characteristics.

RESULTS

The proportion of age-eligible women screened for breast cancer was 61.9% (n = 1383); county screening rates varied from 12.9% to 100% (mean 60.3%). Failure to complete high school, lower family income, and absence of continuous insurance, a usual source of care, or current employment were associated with lower BCS. After accounting for these characteristics, per capita PCPs (adjusted odds ratio [AOR] 1.05 (1.01, 1.10), p = 0.02) and the proportion of FHH (AOR 0.66 (0.44, 0.99), p = 0.045) remained independently associated with BCS.

CONCLUSIONS

Contextual characteristics independently associated with BCS identify areas in which women are at increased risk for delayed breast cancer diagnosis. The approach described here can inform the planning phase of regional, state, or federal initiatives to enhance BCS and reduce subsequent disparities in treatment outcomes.

Prevalência e fatores associados à realização da mamografia na faixa etária de 50-69 anos: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios (2003)

O presente trabalho foi desenvolvido utilizando dados da Pesquisa Nacional por Amostra de Domicílios de 2003 (PNAD 2003), com o objetivo de estimar a prevalência e os fatores associados à realização da mamografia entre mulheres brasileiras com 50-59 e 60-69 anos de idade. Participaram do estudo 16.570 e 10.722 mulheres nas respectivas faixas etárias. Quarenta e três por cento das participantes com 50-69 anos haviam realizado uma mamografia nos últimos dois anos. Essa prevalência foi mais baixa na faixa etária superior (37%) em comparação à inferior (46%). Em ambas as faixas etárias, a realização da mamografia apresentou associações positivas e independentes com a localização urbana do domicílio, a macrorregião de residência, a escolaridade, a renda domiciliar, o exame de Papanicolau, o número de consultas médicas e a cobertura por plano de saúde. Esses resultados mostram que a cobertura da mamografia ainda é baixa entre mulheres brasileiras, sobretudo entre as mais velhas, e que existem profundas desigualdades associadas à sua realização. Recomenda-se a condução de investigações mais profundas que permitam um melhor entendimento dessas desigualdades, visando a sua superação.

Longitudinal effects of domestic violence on employment and welfare outcomes

This study uses longitudinal data spanning 13 years from a study of 234 adolescent mothers to evaluate the effects of cumulative domestic violence on employment and welfare use before and after welfare reform. Domestic violence increased the odds of unemployment after welfare reform, but not before; domestic violence had no effect on welfare use during any time period. Psychological distress after welfare reform was associated with unemployment, but not with welfare outcomes. Thus, the authors found that the direct effect of domestic violence on unemployment is not mediated by concurrent level of psychological distress. The relationship of psychological distress to unemployment exists only for those with a history of domestic violence. Cumulative domestic violence can have negative effects on economic capacity many years after the violence occurs, suggesting that policymakers recognize the long-term nature of the impact of domestic violence on women's capacity to be economically self-reliant.

The Association Between Inquiry About Emotional Distress and Women's Satisfaction with Their Family Physician: Findings from a National Survey

BACKGROUND

Women appear to be more vulnerable than men to emotional distress (ED) However, ED often goes unrecognized by family physicians.

PURPOSE

To (1) assess the rate of inquiry about ED by family physicians and (2) explore the association between physician's inquiry about ED and women's satisfaction with care.

METHODS

Telephone interviews were conducted in 2003 using a structured questionnaire in a representative sample of 991 Israeli women aged 22 years or older, with a response rate of 84%.

RESULTS

33% of women reported ED during the past year but only 15% of women reported having discussed ED with their family physician in the last year. Higher rates of discussion of ED with the physician were found among women who had experienced ED (22.5%), those who had a chronic illness (20.1%) had low income (22.7%), and were Arabic (29.5%) or Russian speakers (26.3%). Multivariate analysis indicated that women who had discussed ED with their physician expressed higher satisfaction with the physicians professional level (OR = 6.85), attitude (OR = 2.45), spending enough time (OR = 2.90), and listening to the patient (OR = 3.19), compared with women who had not discussed ED with their physician.

CONCLUSIONS

Given the current low rates of inquiry about ED, it appears that developing sensitivity to women's emotional concerns and encouraging physicians to inquire about ED should be given higher priority in medical education at all levels. Furthermore, since inquiry about ED not only improves the appropriateness of care but is also associated with higher satisfaction with the physician, organizations in a competitive health care environment may have a particular interest in promoting this practice.

A captive audience: bringing the WISEWOMAN program to South Dakota prisoners

PURPOSE

This analysis compares the baseline heart disease risk profile of WISEWOMAN participants screened in the South Dakota Women's Prison with the general WISEWOMAN population in South Dakota and explores the potential benefits of lifestyle intervention programs to reduce heart disease risk factors among women during incarceration.

METHODS

Using baseline data for WISEWOMAN participants in South Dakota, we compared participants who were enrolled in prison (n = 261) with nonincarcerated participants enrolled throughout the state (n = 1,427). Using regression analysis and adjusting for demographics, we assessed differences in baseline prevalence of risk factors (hypertension, high cholesterol, smoking, and obesity), awareness and treatment of hypertension and high cholesterol, and attendance at lifestyle intervention sessions.

RESULTS

Incarcerated participants had significantly lower (p < .01) total cholesterol (183 mg/dL) than nonincarcerated participants (199 mg/dL). However, a significantly higher (p < .03) percentage of incarcerated women (85%) than nonincarcerated women (54%) with high cholesterol were unaware of their condition. Despite the smoke-free status of the prison, 24% of incarcerated participants reported smoking. Attendance at lifestyle intervention sessions was significantly higher among incarcerated participants than among nonincarcerated participants with intervention take-up rates of 53% among incarcerated versus 23% among nonincarcerated women (p < .01) and intervention completion rates of 43% and 4% (p < .01).

CONCLUSIONS

The results illustrate the need for screening and education programs in prisons. WISEWOMAN screenings helped identify undiagnosed cases of abnormal blood pressure and cholesterol, and educational interventions provided women with opportunities to improve their health. Such programs may also improve discharge planning and linkages between released women and community health providers.

Health, mental health, substance use, and service utilization among rural and urban incarcerated women

Incarcerated women commonly report health, mental health, and substance use problems, yet there is limited research on service utilization before incarceration, particularly among women from urban and rural areas. This study includes a stratified random sample of 100 rural and urban incarcerated women to profile the health, mental health, substance use, and service utilization; examine the relationship between the number of self-reported problems and service utilization; and examine self-reported health and mental health problems in prison as associated with preincarceration health-related problems and community service utilization. Study findings suggest that health and mental health problems and substance use do not differ significantly among rural and urban women prisoners. However, there are differences in service utilization -- particularly behavioral health services including mental health and substance abuse services; urban women report more service utilization. In addition, rural women who reported using needed community services before prison also reported fewer health problems in prison. Implications for correctional and community treatment opportunities in rural and urban areas are discussed.

Home care needs of extremely obese elderly European women

OBJECTIVE

To examine the health and needs of extremely obese women aged over 65 years receiving home care in Europe.

STUDY DESIGN

A cross-sectional assessment study based on the Aged in Home Care (AdHOC) project recruited 2974 women aged 65 or over who were receiving home care at 11 sites in European countries. Extreme obesity was defined as 'Obesity of such a degree as to interfere with normal activities, including respiration'.

MAIN OUTCOME MEASURES

Resident Assessment Instrument for Home Care (RAI-HC version 2.0); Activity of Daily Living Scale; Instrumental Activity of Daily Living Scale; the Minimum Data Set Cognitive Performance Scale; and a health profile.

RESULTS

One hundred and twenty women (4.0%) were extremely obese. They were younger than their thinner counterparts, with a median age of 78.3 versus 83.3 years, and they more often had multiple health complaints and needed more help with mobility outside the home. The extremely obese had received home care longer than the non-extremely obese (median 28.7 versus 36.6 months). Extremely obese women also needed more help with personal care than the other group and, due to lower age, they were less cognitively impaired.

CONCLUSIONS

Extreme obesity is a problem that increasingly affects home care of elderly women.

The Characteristics of Middle Aged Australian Women who Consult Acupuncturists

Background

Although an increase in the use of acupuncture in recent years has been identified, there are few studies that focus attention upon the characteristics of acupuncture users. This survey aimed at providing a first step towards addressing this significant research gap.

Methods

This study was conducted as part of the Australian Longitudinal Study on Women's Health, and examined the characteristics of acupuncture users among middle aged Australian women between 50 and 55 years old. Data were collected on demographic measures, health status and health service use.

Results

The paper reports on 11 202 middle aged women, surveyed in 2001. We estimate that 4.5% of middle aged women consult an acupuncturist. Women who consult an acupuncturist are less likely to be married or living in a de facto relationship, are more likely to have had a major personal illness in the previous year, to have suffered from a variety of symptoms or have significantly lower scores (ie poorer health) on all eight dimensions of the SF-36 health-related quality of life scale. Women who use acupuncture are also higher users of ‘conventional’ health services.

Conclusion

While the development of a research base and clinical applications for acupuncture are ongoing, health professionals should be aware that acupuncture is currently being used by large numbers of middle aged women. In addition, given the relatively higher prevalence of acupuncture use reported in our study, it is important that further research explores acupuncture use in more detail and the relationship between women's health issues and their use and experience of acupuncture.

Increasing access to safe abortion services in rural India: experiences with medical abortion in a primary health center

INTRODUCTION

To increase access to safe abortion in rural India, the feasibility and acceptability of mifepristone-misoprostol abortion was assessed in a typical government run primary health center (PHC) in Nagpur district, Maharashtra State, that does not offer surgical abortion services and must refer off-site for emergency and backup services.

MATERIALS AND METHODS

Consenting pregnant women (n=149) with <or=56 days amenorrhea seeking terminations received 200 mg mifepristone, and returned 48 h later for 400-microg sublingual misoprostol and 12 days later for abortion confirmation. Surgical backup was conducted at a nearby community health center (CHC).

RESULTS

Nearly all women (98.6%) with known outcomes had successful medical abortions, and those who did not (1.4%) were successfully referred to the CHC for surgical backup. Women reported the method's ease and simplicity as the best features.

CONCLUSION

Medical abortion provision is feasible and acceptable in an Indian rural PHC that does not offer surgical abortion services. This study suggests that introduction of medical abortion at lower levels of the health-care system could increase access to safe abortion in rural India.

Provider management of menopause after the findings of the Women's Health Initiative

OBJECTIVE

A survey was conducted to determine current provider behaviors and concerns related to menopause management.

DESIGN

All gynecology, internal medicine, and family medicine providers (both physicians and nurse practitioners) within a large Midwestern integrated health system were surveyed about current approaches to menopause management, frequency and reasons for hormone therapy (HT) use, approaches to HT discontinuation, treatments for symptom control, bone mineral density testing, and concerns related to menopause management. Descriptive statistics and chi-square tests were performed to examine frequencies and differences based on gender, specialty, and years in practice.

RESULTS

Overall the response rate was 58% with providers from owned clinics, with female providers being the most likely to respond (P < 0.001). Changes in menopause management included using lower dose hormones (74%), encouraging use for shorter time periods (73%), and using different modes of delivery (21%). Most providers (89%) initiate HT use in symptomatic patients, and only 12% initiate use to prevent symptoms. Patients were most likely to discuss HT with gynecologists (78% gynecologists vs 64% family medicine providers and 48% internal medicine providers, P = 0.015). Nearly two thirds of providers (64%) claimed to order bone mineral density testing frequently. Providers' concerns related to information on symptom management, alternative and over-the-counter medications, the risk/benefits of medications, patients' sexual concerns, and maintaining bone health.

CONCLUSIONS

We found that providers were responsive to current literature, shifting the agents and dosages they prescribe. Still they are faced with women reporting symptoms that interfere with their ability to function optimally and must continue to help women maintain healthy bones.

Pregnancy during Operation Iraqi Freedom/Operation Enduring Freedom

OBJECTIVE

The purpose of this study was to evaluate pregnancy during war-time deployment.

METHODS

A retrospective review of gynecology visits was evaluated at Camp Doha, Kuwait, from August 2003 through April 2004. Of the 1,737 visits, 77 demonstrated a positive pregnancy test. These charts were evaluated for factors that may lead to important information for future deployments.

RESULTS

The average age of the female soldier with a positive pregnancy test in theater was 27 +/- 7 years. The primary presenting complaint was amenorrhea. Ninety-two percent had an ultrasound. Fifty-four percent of visits were active duty, followed by Reserve, National Guard, and civilian government employees. Ninety-two percent were administratively redeployed. Seventy-seven percent of the soldiers became pregnant in country. Twenty-three percent arrived in country pregnant.

CONCLUSIONS

Given the number of pregnancies before and during deployment, current screening procedures as well as new concepts in prevention need to be addressed.

Women's perception of self-worth and access to health care

OBJECTIVE

: Research has shown differences in health status and health care utilization related to culture, economic status, and health care development. This paper reports on a study comparing attitudes of women in three countries, at various stages of development, about their own health and self-worth and asks if these differences account for differences in health care utilization and inequities in health status.

METHOD

: A questionnaire, administered to 100 women in each of Yemen, Uganda and Canada, explored women's perception of their own health and health care seeking behavior.

RESULT

: Women's perception of themselves as worthy of care was positively related to utilization. The ability to make one's own health care decisions varied with her country's development level. Implementation strategies must consider women's decision-making capacity.

CONCLUSION

: To achieve improved health status, policies and programs must commit to encouraging appropriate social and cultural changes, using a 'cross-sectoral approach', involving both gender and development issues.

Couples' reports of women's autonomy and health-care use in Nepal

Using data from interviews with matched couples recorded in the 2001 Nepal Demographic and Health Survey, this report explores how incorporating both spouses' reports of household decisionmaking may change the understanding of the determinants and consequences of women's autonomy. Results indicate that a substantial proportion of couples disagree about who makes household decisions, but the determinants of women's autonomy are still largely similar according to both spouses'reports. The assessment of the effects of two important sources of autonomy--women's education and employment--differs significantly between spouses, however. When spouses agree that the wife is autonomous, the association between her autonomy and her use of health-care services is found to be substantially stronger than when spouses disagree about her autonomy. This finding suggests that the association between women's autonomy and health-care-service use may be underestimated when only women's reports are considered.

The cost of being a woman: a national study of health care utilization and expenditures for female-specific conditions

PURPOSE

An important component of women's health care is for conditions that are exclusive to women, yet little research has addressed the economic impact of health care for these conditions. The purpose of this study was to describe health care utilization for female-specific conditions, the incremental expenditures attributable to these conditions, and the overall incremental expenditures across the lifespan.

METHODS

We analyzed 3 years of a nationally representative survey of the US noninstitutionalized population, the 2000-2002 National Medical Expenditure Panel Survey, which included 25,361 females aged > or =14, representing 38,170 person-years.

RESULTS

More than one fifth of women (21.2%) reported having a female-specific condition during a 1-year period, the most common of which were gynecologic disorders (7.4%); pregnancy-related conditions (6.4%); and menopausal symptoms (5.3%). The mean increment in annual total expenditures attributable to female-specific conditions ranged from $483 for menopausal disorders to $3,896 for female cancers. The annual total health care expenditures of women with female-specific conditions were estimated to be $108 billion, of which >40% ($43.3 billion) was attributable to female-specific conditions. Women with female-specific conditions who had no health insurance were less likely to have visited a doctor (p = .0002), filled a prescription (p = .001), and been hospitalized (p = .0001) for these conditions, but more likely to have visited an emergency department (p = .02) seeking treatment for these conditions.

CONCLUSIONS

In this nationally representative sample of American women aged > or =14, female-specific conditions were common and substantially increased costs of health care.

Mobile mammography: assessment of self-referral in reaching medically underserved women

BACKGROUND

Mobile mammography can be useful in reaching medically underserved women. However, it is not known whether self-referral for mobile mammography is the best approach for reaching the most vulnerable populations.

OBJECTIVES

1) To describe the community outreach patterns of a county-sponsored mobile mammography unit, 2) To characterize the follow-up patterns for women with abnormal screening mammograms, and 3) to identify reasons why women screened on mobile units seek follow-up care outside of the safety-net system.

METHODS

We prospectively followed women aged > or = 40 years who received mobile mammograms using electronic records and medical chart review, and surveyed women who had no evidence of diagnostic follow-up. We also reviewed administrative records to determine outreach patterns of the mobile mammography units.

RESULTS

Seventy-five percent of mobile visits were with community-based organizations or community health centers. At least one quarter of women chose to follow-up outside of the safety-net for evaluation of abnormal screening mammograms. Of these, nearly 40% reported having insurance or a private physician as the primary reason for having diagnostic evaluation outside of the public hospital system.

CONCLUSIONS

Despite serving primarily community-based facilities, self-referral for mobile mammography may not optimally target medically underserved women most in need of breast cancer screening.

Actuarial analysis of private payer administrative claims data for women with endometriosis

BACKGROUND

Endometriosis is a painful, chronic disease affecting 5.5 million women and girls in the United States and Canada and millions more worldwide. The usual age range of women diagnosed with endometriosis is 20 to 45 years. Endometriosis has an estimated prevalence of 10% among women of reproductive age, although estimates of prevalence vary greatly. Endometriosis is the most common gynecological cause of chronic pelvic pain, but published information on its associated medical care costs is scarce.

OBJECTIVE

The aim of this study was to determine (1) the prevalence of endometriosis in the United States, (2) the amount of health care services used by women coded with endometriosis in a commercial medical claims database during 1999 to 2003, and (3) the endometriosis-related costs for 2003, the most recent data available at the time the study was performed.

METHODS

This study was a retrospective review of administrative data for commercial payers, which included enrollment, eligibility, and claims payment data contained in the Medstat Marketscan database for approximately 4 million commercial insurance members. All claims and membership data were extracted for each woman aged 18 to 55 years who had at least 1 medical or hospital claim with a diagnosis code for endometriosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 617.00-617.99) for 1999 through 2003. Claims data from 1999 through 2003 were used to determine prevalence and health care resource utilization (i.e., annual admission rate, annual surgical rate, distribution of endometriosis-related surgeries, and prevalence of comorbid conditions). The cost analysis was based on claims from 2003 only. Cost was defined as the payer-allowed charge, which equals the net payer cost plus member cost share.

RESULTS

The prevalence of women with medical claims (inpatient and/or outpatient) containing ICD-9-CM codes for endometriosis was 1.1% for the age band of 30 to 39 years and 0.7% over the entire age span of 18 to 55 years. The medical costs per patient per month (PPPM) for women with endometriosis were 63% greater ($706 PPPM) than those of the average woman per member per month ($433) in 2003; inpatient hospital costs accounted for 32% of total direct medical costs. Between 1999 and 2003, these women with endometriosis who were identified by either inpatient and/or outpatient claims had high rates of hospital admission (53% for any reason; 38% for an endometriosis-related reason) and a high annual surgical procedure rate (64%). Additionally, women with endometriosis frequently suffered from comorbid conditions, and these conditions were associated with greater PPPM costs of 15% to 50% for women with an endometriosis diagnosis code, depending on the condition. Interstitial cystitis was associated with 50% greater cost ($1,061 PPPM); depression, 41% ($997 PPPM); migraine, 40% ($988 PPPM); irritable bowel syndrome, 34% ($943 PPPM); chronic fatigue syndrome, 29% ($913 PPPM); abdominal pain, 20% ($846 PPPM); and infertility, 15% ($813 PPPM).

CONCLUSIONS

Women with endometriosis have a high hospital admission rate and surgical procedure rate and a high incidence of comorbid conditions. Consequently, these women incur total medical costs that are, on average, 63% higher than medical costs for the average woman in a commercially insured group.

Disability and receipt of clinical preventive services among women

BACKGROUND

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.

METHODS

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.

RESULTS

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,

CONCLUSIONS

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.

Diabetes care among veteran women with disability

OBJECTIVE

The primary objective of this study was to analyze predictors of diabetes care consistent with performance standards among women Veterans Health Administration (VHA) clinic users with disability enrollment status.

METHODS

This is a retrospective cohort study using VHA and Medicare files of VHA clinic users with diabetes. Diabetes care measures consisted of annual testing for hemoglobin A(1c) (HbA(1c)), low-density lipoprotein cholesterol (LDL-C), and poor HbA(1c) (>9%) and LDL-C (> or =130 mg/dL) control in fiscal year 2000. Chi-square tests and logistic regressions were used to assess subgroup differences in diabetes care. Independent variables included demographic characteristics and physical and psychiatric comorbidities.

POPULATION

Study population was based on veteran women <65 years of age who used VHA clinics; we identified 2,344 women as having coexisting disability and diabetes and 2,766 women with diabetes and without disability.

FINDINGS

Among veteran women with diabetes and disability, 65% received > or =1 HbA(1c) test, and 54% received a LDL-C test; 25% and 30% had poor HbA(1c) and LDL-C control, respectively. In logistic regressions, none of the independent variables had significant effects on poor HbA(1c) or LDL-C control, except that African Americans were more likely to have poor HbA(1c) control than whites. Significant age effects were noted in rates of HbA(1c) and LDL testing. Comparison of diabetes care measures between women with and without disability indicated that those with disability were more likely to receive HbA(1c) and LDL-C tests; no significant differences in HbA(1c) and LDL-C control were noted.

CONCLUSIONS

Disability status of women veterans was not a barrier to diabetes care consistent with performance standards. Our findings suggest that to improve diabetes care, subgroup-specific interventions, rather than a global approach, are warranted.

How Depression Influences The Receipt of Primary Care Services among Women: A Propensity Score Analysis

BACKGROUND AND OBJECTIVES

Many patients with psychiatric disorders do not receive appropriate medical services, whereas others receive unnecessary medical services. This study investigated whether female primary care patients with depression were more or less likely to receive preventive/diagnostic tests.

METHODS

Preventive/diagnostic tests for females with depression or hypertension or both over a 5-year period were extracted from an electronic medical record (EMR) used at a university-based family practice clinic. Tests extracted included cholesterol screening, mammogram, Pap smear, and colonoscopy.

RESULTS

Of 860 included in the analysis, 270 were diagnosed with depression, 380 with hypertension, and 210 with both conditions. Women with depression were significantly more likely to receive colonoscopies and Pap smears than women with hypertension. Hypertensive patients were significantly more likely to have their cholesterol checked.

CONCLUSIONS

Somatization associated with depression may lead to more preventive and diagnostic testing among female primary care patients.

Mammographic referral patterns for two breast imaging units in Jamaica

OBJECTIVE

In countries that have instituted national mammographic screening programmes, mortality from breast cancer has decreased by as much as 63%. Although mortality rates from breast cancer in Jamaica are high, there is no national mammographic screening programme. In this context, opportunistic screening, which depends on contact between healthcare provider and patient, as well as self-referral become important. Therefore, the authors sought to determine the source of referrals for women who had mammography.

SUBJECTS AND METHODS

The variables of age, indication for mammography, source of referral and referring physician area of specialty if applicable were extracted from the attendance records for all patients who had mammography at the breast imaging unit at the University Hospital of the West Indies (UHWI) and Radiology West (RadWest) in the year 2003.

RESULTS

There were 779 bilateral mammograms done at UHWI of which 452 (58%) were screening and 1223 mammograms done at RadWest of which 657 (54%) were screening. The difference in proportion of self-referral between the two facilities was significantly different (p < 0. 001). Of the 452 screening mammograms performed at UHWI, 329 (73%) were self-referred, 31 (7%) were from primary care, 18 (4%) from gynaecologists and 17 (4%) from general surgeons. In contrast, of the 657 screening mammograms, at Radwest, 92 (14%) were self-referred, 323 (49%) were from primary care, 47 (7%) from gynaecologists and 37 (6%) from general surgeons.

CONCLUSION

To increase the utilization and hence effectiveness of screening mammography, programmes targeting healthcare professionals, particularly gynaecologists and the public are needed.