Chan L, Doctor J N, MacLehose R F, Lawson H, Rosenblatt R A, Baldwin L M, Jha A
Department of Rehabilitation Medicine, University of Washington, Health Care Financing Administration, Seattle 98121, USA.
Arch Phys Med Rehabil. 1999 Jun;80(6):642-6. doi: 10.1016/s0003-9993(99)90166-1.
To compare health maintenance procedure rates of Medicare patients with different levels of disability.
Observational study analyzing data from the 1995 Medicare Current Beneficiary Survey (MCBS, n = 15,590). Self-reported Pap smears, mammograms, and influenza and pneumococcal vaccinations were compared between groups with different levels of health-related difficulties in six activities of daily living (ADL).
Compared to those without disabilities, the most severely disabled women (limitations in 5 or 6 ADL) reported fewer Pap smears (age < or =70, 23% vs 41%, p < .001) and mammograms (age > or = 50, 13% vs 44%, p < .001). In a controlled analysis, individuals with 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 smears and mammograms, respectively, compared with able-bodied women, regardless 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 receiving vaccinations. In general, patients in HMOs reported more procedures than those in fee-for-service, while those in long-term care facilities reported fewer procedures than those living in the community.
Disability among Medicare patients is a significant, independent risk factor for not receiving mammograms and Pap smears. Efforts should be made to identify the most severely disabled because they are at particular risk.
比较不同残疾程度的医疗保险患者的健康维护程序使用率。
观察性研究，分析1995年医疗保险当前受益调查（MCBS，n = 15,590）的数据。比较了在六项日常生活活动（ADL）中具有不同健康相关困难程度的组之间自我报告的巴氏涂片检查、乳房X线摄影以及流感和肺炎球菌疫苗接种情况。
与无残疾者相比，残疾最严重的女性（在5项或6项ADL中有功能受限）报告的巴氏涂片检查较少（年龄≤70岁，23%对41%，p <.001），乳房X线摄影也较少（年龄≥50岁，13%对44%，p <.001）。在一项对照分析中，与身体健全的女性相比，无论年龄大小、是否参加健康维护组织（HMO）或是否住在长期护理机构，这种高度残疾的个体报告接受巴氏涂片检查和乳房X线摄影的可能性分别降低了57%（95%置信区间[CI]，33%至72%）和56%（95%CI，43%至76%）。功能受限并不是接种疫苗的阻碍。总体而言，HMO中的患者报告的程序比按服务收费的患者更多，而长期护理机构中的患者报告的程序比社区中的患者更少。
医疗保险患者中的残疾是未接受乳房X线摄影和巴氏涂片检查的一个重要独立风险因素。应努力识别残疾最严重的患者，因为他们面临特别的风险。
