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Friedman C, VanPuymbrouck L. People with Disabilities' Access to Medical Care During the COVID-19 Pandemic. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:373-386. [PMID: 38032296 DOI: 10.1080/19371918.2023.2288352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Delaying and forgoing medical care intensifies the health disparities and unmet needs people with disabilities already face. While many people with disabilities were at high risk for COVID-19, less is known about their access to medical care during the pandemic. This study explored people with disabilities' access to medical care during the COVID-19 pandemic. We analyzed United States Census Bureau COVID-19 Household Pulse Survey data from the second year of the pandemic (April-July 2021) from people with (n = 38,512) and without (n = 296,260) disabilities. During the second year of the pandemic, 30.8% of people with disabilities delayed getting medical care and 28.9% forwent needed care. People with disabilities were also significantly more likely to delay and forgo medical care than people without disabilities. Attention must be drawn to the unmet needs of people with disabilities and efforts must be made to expand their access to health care.
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Affiliation(s)
- Carli Friedman
- The Council on Quality and Leadership (CQL), Towson, Maryland, USA
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KHANGHAH ROZITAMOHAMADI, BESHARATI FERESHTEH, POURGHANE PARAND, GHOLAMI-CHABOKI BAHAREH. Status of the utilization of preventive care services and its associated socio-demographic factors among Iranian elderly. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E188-E197. [PMID: 37654856 PMCID: PMC10468182 DOI: 10.15167/2421-4248/jpmh2023.64.2.2913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/20/2023] [Indexed: 09/02/2023]
Abstract
Introduction The growing population of the elderly, the rising costs of medical care and the low use of preventive services are three factors that highlight the importance of using preventive health care services in the Iranian population. This study aimed to determine the status of the use of preventive care services and its associated socio-demographic factors in the elderly referred to health centers. Methods In this analytical cross-sectional study, a number of 160 elderly people referred to health centers in East Guilan, Iran was selected by multi-stage cluster sampling. Data were obtained from May to September, 2021 using a questionnaire containing utilization of preventive care services (9 items) and socio-demographic characteristics. Results The highest and the lowest utilization rates of preventive care services among study participants were related to the blood pressure test (96.9%) and colonoscopy (17.5%), respectively. Multivariate analysis showed that only income had a significant association with performing fasting blood sugar test (p = 0.004), blood lipid test (p = 0.004), and blood pressure test (p = 0.013). Also, the associations between having an underlying disease and performing fasting blood sugar test (p = 0.032) and blood pressure test (p = 0.002), the association between gender and performing the bone mineral density test (p < 0.001), and the association between occupation and performing Pap-smear test (p = 0.011), were statistically significant. Conclusions The utilization rates of screening tests for most cancers, including gastrointestinal cancers, were low. Since, there were a significant association between income, disease, gender and occupation with the utilization of some preventive care services, considering them in health centers' preventive care program design might be useful.
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Affiliation(s)
- ROZITA MOHAMADI KHANGHAH
- MSC Student of Geriatric Nursing, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - FERESHTEH BESHARATI
- Assistant Professor, PhD in Department of Nursing, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - PARAND POURGHANE
- Associate Professor, PhD in Department of Nursing, Zeynab [P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - BAHAREH GHOLAMI-CHABOKI
- Assistant Professor, PHD in Cardiovascular Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Factors Associated with Lack of Health Screening among People with Disabilities Using Andersen's Behavioral Model. Healthcare (Basel) 2023; 11:healthcare11050656. [PMID: 36900661 PMCID: PMC10000362 DOI: 10.3390/healthcare11050656] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
People with disabilities often have poorer health than the general population, and many do not participate in preventive care. This study aimed to identify the health screening participation rates of such individuals and investigate why they did not receive preventive medical services based on Andersen's behavioral model, using data from the Survey on Handicapped Persons with Disabilities. The non-participation health screening rate for people with disabilities was 69.1%. Many did not in health screening because they showed no symptoms and were considered healthy, in addition to poor transportation service and economic limitations. The binary logistic regression result indicates that younger age, lower level education, and unmarried as predisposing characteristics; non-economic activity as the enabling resources; and no chronic diseases, severe disability grade, and suicidal ideation as need factor variables were the strongest determinants of non-participation health screening. This indicates that health screening of people with disabilities should be promoted while takings into account the large individual differences in socioeconomic status and disability characteristics. It is particularly necessary to prioritize ways to adjust need factors such as chronic disease and mental health management, rather than focusing on uncontrollable predisposing characteristics and enabling resources among barriers to participation in health screening for people with disabilities.
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Thorpe D, Gannotti M, Peterson MD, Wang CH, Freburger J. Musculoskeletal diagnoses, comorbidities, and physical and occupational therapy use among older adults with and without cerebral palsy. Disabil Health J 2021; 14:101109. [PMID: 33933399 DOI: 10.1016/j.dhjo.2021.101109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Musculoskeletal (MSK) disorder in adults with cerebral palsy (CP) is higher than in the general population. Evidence lacks about physical therapy (PT) and occupational therapy (OT) service utilization among older adults (65> years) living with CP. OBJECTIVE We compared the presence of comorbidities and patterns of PT and OT use among older adults with and without CP seeking care for MSK disorders. METHODS A 20% national sample of Medicare claims data (2011-2014) identified community-living older adults with (n = 8796) and without CP (n = 5,613,384) with one or more ambulatory claims for MSK diagnoses. The sample matched one CP case to two non-CP cases per year on MSK diagnoses, age, sex, race, dual eligibility, and census region. Exposure variable was the presence/absence of a CP diagnosis. Outcomes were use of PT and OT services identified via CPT and revenue center codes, and the presence/absence of Elixhauser comorbidities. RESULTS In older adults with MSK diagnoses, less than a third regularly utilized PT and/or OT services, and adults with CP utilized significantly less PT than adults without CP, and for some MSK diagnoses had fewer visits than their matched peers. Older adults with CP were at greater risk for secondary conditions that influence morbidity, mortality, and quality of life compared to their age-matched peers without CP. CONCLUSIONS Older adults with CP and MSK diagnoses had a greater prevalence of numerous comorbidities and lower use of PT services relative to their non-CP peers.
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Affiliation(s)
- Deborah Thorpe
- Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Mary Gannotti
- Department of Rehabilitation Sciences, University Hartford, West Hartford, CT, USA.
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Chin-Hua Wang
- Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Janet Freburger
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
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Mellor JM, McInerney M, Sabik LM. Misclassification of Medicaid Participation by Dual Eligibles: Evidence From the Medicare Current Beneficiary Survey. Med Care Res Rev 2021; 78:113-124. [PMID: 31286831 PMCID: PMC6949419 DOI: 10.1177/1077558719858839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous studies show that survey-based reports of Medicaid participation are measured with error, but no prior study has examined measurement error in an important segment of the Medicaid population-low-income adults enrolled in Medicare. Using the Medicare Current Beneficiary Survey, we examine whether respondent self-reports of Medicaid enrollment match administrative records and present several key findings. First, among low-income Medicare beneficiaries, the false negative rate is 11.5% when the self-report is interpreted as full Medicaid and 3.7% when the self-report is interpreted as full or partial Medicaid. Second, the likelihood of a false negative report is systematically associated with respondent traits. Third, systematic measurement error results in biased coefficient estimates in models of Medicaid participation defined from self-reports, and the bias is more significant when the researcher interprets self-reports as full Medicaid coverage only. Researchers should use caution when interpreting survey reports as pertaining to full Medicaid coverage only.
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Reichard A, Haile E, Morris A. Characteristics of Medicare Beneficiaries With Intellectual or Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:405-420. [PMID: 31568735 DOI: 10.1352/1934-9556-57.5.405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Gaps in knowledge and systematic tracking of the prevalence of intellectual and developmental disabilities (IDD) and characteristics that may affect the health of this disability group limits our ability to address the health disparities they experience in comparison to people without disability. The purpose of this study is to begin to fill one relevant critical gap in knowledge: understanding the demographics and health outcomes of adults with IDD who receive services under Medicare Fee-for-Service (FFS), many of who are also eligible for Medicaid. Using 2016 Medicare administrative claims, we examined the prevalence and characteristics of five diagnosis groups of IDD, in those under 65 and those 65 and over, as well as their health outcomes. We found that the IDD Medicare FFS group had high prevalence rates for chronic physical and mental health conditions, overuse of emergency departments, and high rate of 30-day readmission. These findings highlight the need for evidence-based health care coordination, improved and increased public health interventions, and continued surveillance.
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Affiliation(s)
- Amanda Reichard
- Amanda Reichard, Administration for Community Living; Elsa Haile, Centers for Medicare and Medicaid Services; and Andrew Morris, Administration for Community Living
| | - Elsa Haile
- Amanda Reichard, Administration for Community Living; Elsa Haile, Centers for Medicare and Medicaid Services; and Andrew Morris, Administration for Community Living
| | - Andrew Morris
- Amanda Reichard, Administration for Community Living; Elsa Haile, Centers for Medicare and Medicaid Services; and Andrew Morris, Administration for Community Living
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Progovac AM, Cook BL, Mullin BO, McDowell A, Sanchez R MJ, Wang Y, Creedon TB, Schuster MA. Identifying Gender Minority Patients' Health And Health Care Needs In Administrative Claims Data. Health Aff (Millwood) 2018; 37:413-420. [PMID: 29505378 PMCID: PMC5942884 DOI: 10.1377/hlthaff.2017.1295] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health care utilization patterns for gender minority Medicare beneficiaries (those who are transgender or gender nonbinary people) are largely unknown. We identified gender minority beneficiaries using a diagnosis-code algorithm and compared them to a 5 percent random sample of non-gender minority beneficiaries from the period 2009-14 in terms of mental health and chronic diseases, use of preventive and mental health care, hospitalizations, and emergency department (ED) visits. Gender minority beneficiaries experienced more disability and mental illness. When we adjusted for age and mental health, we found that they used more mental health care. And when we adjusted for age and chronic conditions, we found that they were more likely to be hospitalized and to visit the ED. There were several small but significant differences in preventive care use. Findings were similar for disabled and older cohorts. These findings underscore the need to capture gender identity in health data to better address this population's health needs.
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Affiliation(s)
- Ana M Progovac
- Ana M. Progovac ( ) is a senior scientist in the Health Equity Research Lab in the Department of Psychiatry, Cambridge Health Alliance, in Cambridge, and an instructor in the Department of Psychiatry, Harvard Medical School, in Boston, both in Massachusetts
| | - Benjamin Lê Cook
- Benjamin Lê Cook is director of the Health Equity Research Lab and director of research in the Department of Psychiatry, Cambridge Health Alliance, and an assistant professor in the Department of Psychiatry, Harvard Medical School
| | - Brian O Mullin
- Brian O. Mullin is a senior analyst in Health Equity Research Lab and the Children's Health Initiative in the Department of Psychiatry, Cambridge Health Alliance
| | - Alex McDowell
- Alex McDowell is a PhD student in the Department of Health Care Policy, Harvard Medical School, and a research assistant at the Health Equity Research Lab in the Department of Psychiatry, Cambridge Health Alliance
| | - Maria Jose Sanchez R
- Maria Jose Sanchez R. is a research assistant in the Health Equity Research Lab in the Department of Psychiatry, Cambridge Health Alliance
| | - Ye Wang
- Ye Wang is a research scientist in the Disparities Research Unit, Massachusetts General Hospital, in Boston
| | - Timothy B Creedon
- Timothy B. Creedon is a researcher at IBM Watson Health in Cambridge, Massachusetts. At the time this work was conducted, he was a research associate in the Health Equity Research Lab in the Department of Psychiatry, Cambridge Health Alliance
| | - Mark A Schuster
- Mark A. Schuster is founding dean and CEO of the Kaiser Permanente School of Medicine, in Pasadena, California. At the time this work was conducted, he was chief of the Division of General Pediatrics, Boston Children's Hospital, and the William Berenberg Professor of Pediatrics in the Department of Pediatrics, Harvard Medical School
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Adams ME, Marmor S, Yueh B, Kane RL. Geographic Variation in Use of Vestibular Testing among Medicare Beneficiaries. Otolaryngol Head Neck Surg 2016; 156:312-320. [DOI: 10.1177/0194599816676450] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective There is a lack of consensus regarding the indications for vestibular testing in the evaluation of dizziness and balance disorders. Geographic variation in health services utilization is associated with lack of consensus. To understand the variation in current practice, we investigated the patterns of use of vestibular testing and diagnosis codes for dizziness and balance disorders among individuals ≥65 years of age across different regions of the United States. Study Design Cross-sectional study. Setting Medicare administrative claims data. Subjects and Methods Using the Summarized Denominator file, a sample of the US population linked to the Surveillance, Epidemiology, and End Results (SEER)–Medicare files (years 2000-2010), we identified persons who were ≥65 years of age. We used multivariable analyses to determine the factors associated with vestibular testing and diagnoses. Results Of the 231,984 eligible Medicare beneficiaries, 27% were diagnosed with dizziness and balance disorders. Patterns of use of vestibular tests (eye movement recording for spontaneous nystagmus, caloric testing, and rotary chair testing) varied significantly by geographic region. Rotary chair test utilization varied most. We found significant geographic variation in vestibular testing and diagnoses after controlling for age, sex, race, Medicaid participation, and rurality. Conclusions There may be opportunities to improve the consistency and efficiency of care for dizziness and balance disorders. It will be important to define appropriate levels of vestibular diagnostic testing and which tests add sufficient value to justify the costs. Further work is needed to better characterize the causes and consequences of variation in vestibular test utilization.
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Affiliation(s)
- Meredith E. Adams
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Schelomo Marmor
- Department of Surgery and Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bevan Yueh
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert L. Kane
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Potter AJ, Trivedi AN, Wright B. Younger Dual-Eligibles Who Use Federally Qualified Health Centers Have More Preventable Emergency Department Visits, but Some Have Fewer Hospitalizations. J Prim Care Community Health 2016; 8:3-8. [PMID: 27371525 DOI: 10.1177/2150131916657081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether younger dual-eligibles receiving care at federally qualified health centers (FQHCs) have lower rates of ambulatory care sensitive (ACS) hospitalization and emergency department (ED) visits. DATA SOURCES We used the 100% Medicare Part A and Part B institutional claims from 2007 to 2010 for dual-eligibles younger than 65 years, enrolled in traditional fee-for-service Medicare, who received care at an FQHC or lived in a primary care service area with an FQHC. METHODS Our cross-sectional analysis used negative binomial regressions to model ACS hospitalizations and ED visits as a function of prior year FQHC use. The model adjusted for beneficiary age, gender, race, and chronic diseases, as well as county fixed effects, time trends, and race-FQHC use interactions. RESULTS FQHC use is associated with a decrease in ACS hospitalization rates for whites (2.8 per 1000 persons), but an increase among blacks (2.5 per 1000 persons). FQHC use is also associated with an increase in ACS ED visits, from 27 to 33 more visits per 1000 persons per year, depending on patient race. CONCLUSIONS ACS hospital use is higher for FQHC users than nonusers, but white FQHC users have fewer ACS hospitalizations. More research is needed to understand how this relationship varies within and between centers.
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Affiliation(s)
| | - Amal N Trivedi
- 2 Brown University, Providence, RI, USA
- 3 Providence Veterans Affairs Medical Center, Providence, RI, USA
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Iezzoni LI, Kurtz SG, Rao SR. Trends in Pap Testing Over Time for Women With and Without Chronic Disability. Am J Prev Med 2016; 50:210-9. [PMID: 26372417 DOI: 10.1016/j.amepre.2015.06.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 06/18/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Data from 20 years ago--shortly after passage of the Americans with Disabilities Act--showed that women with significant mobility disability had 40% lower Pap test rates than other women. METHODS To examine whether disability disparities in Pap test rates have diminished over time, this study analyzed National Health Interview Survey responses from selected years between 1998 and 2010 from women aged 21-65 years without histories of cervical cancer or hysterectomy. Seven chronic disability types were identified using self-reported functional impairments or participation limitations. Self-reported Pap testing within the previous 3 years was studied. Bivariable analyses and multivariable logistic regression analyses controlling for sociodemographic variables were conducted in 2014. RESULTS Rates of all chronic disability types increased over time. Pap test rates remained relatively constant over time for all women, holding around 84%-87%. Bivariable analyses found statistically significantly lower rates of Pap testing for women with disability compared with nondisabled women. Multivariable analyses failed to find consistent evidence of lower Pap test rates among women across disability types compared with nondisabled women. In 2010, the AOR for reporting Pap testing for women noting the most severe movement difficulty compared with nondisabled women was 0.35 (95% CI=0.15, 0.79). However, the AOR for this disability type varied over time. CONCLUSIONS Little has changed over time in Pap test rates for all women. Women with certain disabilities continue to experience disparities compared with nondisabled women in receipt of this important screening test.
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Affiliation(s)
- Lisa I Iezzoni
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Stephen G Kurtz
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sowmya R Rao
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Center for Healthcare Organization and Implementation Research (CHOIR), Bedford Veterans Affairs Medical Center, Bedford, Massachusetts
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Gimm G, Blodgett E, Zanwar P. Examining access to care for younger vs. older dual-eligible adults living in the community. Disabil Health J 2015; 9:431-8. [PMID: 26781192 DOI: 10.1016/j.dhjo.2015.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/25/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent state dual-eligible (Medicare and Medicaid) payment reform demonstrations have included groups of both working-age and older adults, but relatively little is known about how access to care varies between these two populations. OBJECTIVES/HYPOTHESIS To examine access to a usual source of care for younger and older dual-eligible adults, to analyze whether timely access to several types of care differed in these two populations, and to understand some of the underlying reasons for delayed care among younger and older dual-eligibles. METHODS Using observations pooled across calendar years 2003-2012 of the Medical Expenditure Panel Survey, this study conducted descriptive and multivariate analyses to examine access to care measures. RESULTS Younger dual-eligible adults were more likely to encounter problems with accessing medical care, dental care, and prescription medications than older dual-eligible adults. Both groups of dual-eligible adults reported that a lack of affordability, gaps in existing insurance coverage, and difficulty in getting to a provider's office were the most common reasons for delayed access to care. CONCLUSIONS A lack of affordability for medical care, dental care, and prescription medications suggests that high co-payments and cost sharing for some services may be deterring access to needed care. Younger dual-eligibles were more likely to encounter service coverage gaps than older dual-eligibles. States should monitor Medicare-Medicaid plans to confirm they have adequate provider networks.
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Affiliation(s)
- Gilbert Gimm
- Department of Health Administration and Policy, George Mason University, Fairfax, VA 22030-4444, USA.
| | - Elizabeth Blodgett
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599-7411, USA
| | - Preeti Zanwar
- Department of Statistics, University of Houston - Clear Lake, Houston, TX 77058, USA
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Iezzoni LI, Kurtz SG, Rao SR. Trends in mammography over time for women with and without chronic disability. J Womens Health (Larchmt) 2015; 24:593-601. [PMID: 26083235 DOI: 10.1089/jwh.2014.5181] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women with disabilities often receive mammograms at lower rates than do nondisabled women, although this disparity varies by disability type and severity. Given the implementation of disability civil rights laws in the early 1990s, we examined whether disability disparities in mammogram use have diminished over time. METHODS We analyzed National Health Interview Survey responses of civilian, noninstitutionalized United States female residents 50 to 74 years old from selected years between 1998 and 2010. We identified seven chronic disability types using self-reported functional impairments, activity/participation limitations, and expected duration. We conducted bivariable and multivariable logistic regression analyses examining associations of self-reported mammogram use within the previous two years with sociodemographic factors and disability. RESULTS Most chronic disability rates rose over time. The most common disability was movement difficulties, with rates increasing from 35.6% (1998) to 39.8% (2010). Mammogram rates for all women remained relatively stable over time, ranging from 72% to 75%. Bivariable analyses generally found statistically significantly lower mammogram rates for women with disability versus nondisabled women. Over time, disparities grew significantly between women with any basic action difficulty or complex activity limitation and nondisabled women (p<0.01). In multivariable logistic analyses, having any difficulty with basic actions was significantly associated with lower adjusted odds of mammography; for example, adjusted odds [95% confidence interval]=0.5 [0.3-0.8], p=0.006, in the model involving movement disability. CONCLUSIONS Little has changed since 1998 in mammogram rates for women with versus without disabilities. Women with certain disabilities continue to experience disparities in mammography testing.
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Affiliation(s)
- Lisa I Iezzoni
- 1 Mongan Institute for Health Policy, Massachusetts General Hospital , Boston, Massachusetts.,2 Department of Medicine, Harvard Medical School , Cambridge, Massachusetts
| | - Stephen G Kurtz
- 3 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts
| | - Sowmya R Rao
- 3 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts.,4 Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center , Bedford, Massachusetts
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Higgins PS, Shugrue N, Ruiz K, Robison J. Medicare and Medicaid Users Speak Out About Their Health Care: The Real, the Ideal, and How to Get There. Popul Health Manag 2015; 18:123-30. [PMID: 25247347 DOI: 10.1089/pop.2014.0056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pamela Sangeloty Higgins
- Ethel Donaghue Center for Translating Research into Practice and Policy, UConn Health, Farmington, Connecticut
- Rehabilitation and Disability Studies Department, Springfield College, Springfield, Massachussetts
| | | | - Kelly Ruiz
- Center on Aging, UConn Health, Farmington, Connecticut
| | - Julie Robison
- Center on Aging, UConn Health, Farmington, Connecticut
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Reichard A, Nary D, Simpson J. Research contributions and implications. Disabil Health J 2014; 7:6-12. [DOI: 10.1016/j.dhjo.2013.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 09/04/2013] [Accepted: 09/22/2013] [Indexed: 10/26/2022]
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Fox MH, Reichard A. Disability, health, and multiple chronic conditions among people eligible for both Medicare and Medicaid, 2005-2010. Prev Chronic Dis 2013; 10:E157. [PMID: 24050527 PMCID: PMC3780711 DOI: 10.5888/pcd10.130064] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction People who are eligible for both Medicare and Medicaid (dual eligibles) and who have disabilities and multiple chronic conditions (MCC) present challenges for treatment, preventive services, and cost-effective access to care within the US health system. We sought to better understand dual eligibles and their association with MCC, accounting for sociodemographic factors inclusive of functional disability category. Methods Medical Expenditure Panel Survey (MEPS) data for 2005 through 2010 were stratified by ages 18 to 64 and 65 or older to account for unique subsets of dual eligibles. Prevalence of MCC was calculated for those with physical disabilities, physical plus cognitive disabilities, and all others, accounting for sociodemographic and health-related factors. Adjusted odds for having MCC were calculated by using logistic regression. Results Of dual eligibles aged 18 to 64, 53% had MCC compared with 73.5% of those aged 65 or older. Sixty-five percent of all dual eligibles had 2 or more chronic conditions, and among dual eligibles aged 65 or older with physical disabilities and cognitive limitations, 35% had 4 or more, with hypertension and arthritis the most common conditions. Dual eligibles aged 18 to 64 who had a usual source of medical care had a 127% increased likelihood of having MCC compared with those who did not have a usual source of care. Conclusion Attention to disability can be a component to helping further understand the relationship between health and chronic conditions for dual eligible populations and other segments of our society with complex health and medical needs.
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Affiliation(s)
- Michael H Fox
- National Center on Birth Defects and Developmental Disabilities, Division of Human Development and Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA.
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Fox MH, Witten MH, Lullo C. Reducing Obesity Among People With Disabilities. JOURNAL OF DISABILITY POLICY STUDIES 2013; 25:175-185. [PMID: 26113785 DOI: 10.1177/1044207313494236] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Achieving healthy weight for people with disabilities in the United States is a challenge. Obesity rates for adults and children with disabilities are significantly higher than for those without disabilities, with differences remaining even when controlling for other factors. Reasons for this disparity include lack of healthy food options for many people with disabilities living in restrictive environments, difficulty with chewing or swallowing food, medication use contributing to changes in appetite, physical limitations that can reduce a person's ability to exercise, constant pain, energy imbalance, lack of accessible environments in which to exercise or fully participate in other activities, and resource scarcity among many segments of the disability population. In order for there to be a coordinated national effort to address this issue, a framework needs to be developed from which research, policy, and practice can emerge. This paper reviews existing literature and presents a conceptual model that can be used to inform such a framework, provides examples of promising practices, and discusses challenges and opportunities moving forward.
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Affiliation(s)
- Michael H Fox
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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