Pap smear testing in a fee-for-service state Medicaid program

Background: The purpose of this study was to identify factors related to persistence with Pap smear screening among female recipients in a fee-for-service state Medicaid program.

Methods: De-identified medical services claims of female recipients in a fee-for-service state Medicaid program who were continuously enrolled from January 1, 2000 to December 31, 2005 and were ≥18 years of age on January 1, 2000 and ≤64 years of age on December 31, 2005 were extracted. Recipients who had a primary diagnosis of cervical cancer (ICD-9-CM 180.XX) or precancerous lesions (ICD-9-CM 622.11, 622.12, 233.1) or had a procedure code for hysterectomy at any time during the six year period were excluded. Persistence was measured as the total number of Pap smear screening that occurred for each recipient during the six year period. Poisson regression model was used to determine association of Pap smear persistence with recipient-related characteristics.

Results: Persistence with pap screening varied by recipients' age, race, and location of residence, respectively. Recipients in the age group 18-29 years had significantly higher persistence in comparison to those in the age group 50-64 years (p<0.001). With respect to race, whites had higher persistence than others (p<0.05). In terms of location, recipients residing in non-metro counties had higher persistence than those residing in metro counties (p<0.001). Poisson regression model showed all three recipient characteristics – age, race, and location – to be significant (p<0.05) predictors of persistence with Pap smear screening.

Conclusion: Interventions designed to improve Pap smear use among indigent females should address these demographic/geographic differences.