221032 PAP screening and gynecologic visit rates for Medicaid enrollees with mental and substance use disorders

Wednesday, November 10, 2010 : 1:30 PM - 1:50 PM

Michael T. Abrams, MPH , Acute care and Policy Research Division, The HIlltop Institute, University of Maryland, Baltimore County, Baltimore, MD
Carol S. Myers, PhD , National Institute on Drug Abuse, Baltimore, MD
Stephanie M. Feldman, MSW, LCSW-C , Treatment Research Program, Maryland Psychiatric Research Center, Baltimore, MD
Susan Chen, MBA , Information Systems and Programming Division, The HIlltop Institute, University of Maryland, Baltimore County, Baltimore
Cynthia Boddie-Willis, MD, MPH , Acute care and Policy Research Division, The HIlltop Institute, University of Maryland, Baltimore County, Baltimore, MD
Junyong Park, PhD , Department of Mathematics & Statistics, University of Maryland, Baltimore County, Baltimore, MD
Robert P. McMahon, PhD , Biostatistics and Data Management, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, Catonsville, MD
Deanna L. Kelly, PharmD, BCPP , Treatment Research Program, Maryland Psychiatric Research Center; University of Maryland School of Medicine, Baltimore, MD
Persons with severe mental illness (SMI) frequently experience other morbidity that is far in excess of that encountered by the general population. Such co-morbidities are intensified for women as they are especially vulnerable to abuse and diseases such as genital cancers and osteoporosis. Preventive somatic care is one obvious way to reduce morbidity in women with SMI. This study used Maryland Medicaid data from 2005 to assess PAP screening and gynecological visit rates experienced by women with non-affective psychosis versus other women with substance use disorder (SUD), bipolar or unipolar depression, or the absence of any of these illnesses (controls). Logistic regression adjusted for age, race, Medicaid eligibility (a proxy for illness severity and Medicaid coverage), HPV, HIV, and other sexually transmitted diseases. Excluding those with hysterectomies or HPV (1% of sample), this modeling found that women with psychosis (n=4,643) or depression (n=2,332) were more likely to receive PAP screening versus controls (n=89,952) (Odds Ratios=1.33, 1.44; 95% Confidence Intervals=1.24-1.44, 1.30-1.58; respectively). Women with SUD with (n=1,066) or without (n=5,905) psychosis demonstrated reduced screening rates (ORs=0.71, 0.77; 95% CIs=0.67-0.76, 0.66-0.90; respectively). Findings were generally weaker for gynecologic visits. Women with psychosis or depression were again more likely to receive such services, while women with SUD were only marginally less likely to receive such services (OR=0.94, 95% CI=0.89-1.00), and those with SUD and psychosis were indistinguishable from controls (OR=1.07, 95% CI=0.95-1.22). These findings suggest adequate gynecologic care utilization for women with psychosis or depression, but sub-standard utilization for persons with SUD.

Learning Areas:
Assessment of individual and community needs for health education
Chronic disease management and prevention
Clinical medicine applied in public health
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
1. Describe how Medicaid administrative data can be used to assess preventative screening in a special population (women with severe mental illness and/or substance abuse) 2. Compare preventative screening rates (PAP smears and gynecolical visits) in persons with psychosis, substance abuse, and others; after adjusting for various demographic factors; STD history, and a proxy for Medicaid coverage status. 3. Analyze whether the screening rates observed appear adequate for women in Medicaid with mental health and substance abuse issues.

Keywords: Mental Illness, Women's Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a co-investigator on the grant funded work. I have an MPH and am working towards my PhD (in disseration phase). I was directly involved, or I directly supervised all the work related to this work.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Maryland's Department of Health and Mental Hygiene Mental health and substance abuse policy analysis Consultant

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.