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Recommendation for and Receipt of Cancer Screenings Among Medicaid Recipients 50 Years and Older
C. Annette DuBard, MD, MPH;
Dorothee Schmid, MA;
Angie Yow, RN;
Anne B. Rogers, BSN, RN, MPH;
William W. Lawrence, MD
Arch Intern Med. 2008;168(18):2014-2021.
Background Persons of low socioeconomic status, including those with Medicaid coverage, are more likely to be diagnosed with cancer at an advanced stage, but little is known about cancer screening practices among Medicaid recipients. Our objective was to identify cancer screening rates among older Medicaid recipients seen in a primary care setting, and to identify patient and physician characteristics associated with screening.
Methods We used a stratified cluster sampling design to select a representative sample of 1951 North Carolina Medicaid recipients 50 years and older. Medical records were reviewed in the office of the primary care provider. Principal outcomes were the documentation of physician recommendations for and patient receipt of screening examinations for colorectal, breast, and cervical cancer.
Results Documentation that colorectal, breast, and cervical cancer screening was recommended by the primary care provider was found for only 52.7%, 60.4%, and 51.5% of eligible patients, respectively. Documented rates of adequate screening were 28.2% for colorectal cancer, 31.7% for mammography within 2 years, and 31.6% for Papanicolaou test within 3 years. When medical record and claims data were combined, approximately half of eligible patients had evidence of screening. Length of the patient-physician relationship and African American race were positively associated with screening.
Conclusions Cancer screening rates among older Medicaid recipients fall far short of national objectives. Lack of a screening recommendation by the physician, rather than patient refusal of recommended tests, accounted for most instances of screening delinquency. Efforts to increase cancer screening rates among Medicaid recipients must address patient, physician, and organizational barriers to the routine identification and delivery of preventive services.
Author Affiliations: Division of Medical Assistance, North Carolina Department of Health and Human Services (Drs DuBard and Lawrence and Ms Yow), and North Carolina State Center for Health Statistics (Ms Schmid), Raleigh; The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill (Dr DuBard); and North Carolina State Health Plan, Durham (Ms Rogers).
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