Recommendation for and Receipt of Cancer Screenings Among Medicaid Recipients 50 Years and Older

Abstract

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.

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

“…15 Physicians who do not offer mammography or who offer extra, nonrecommended breast imaging modalities for screening women not at high risk of breast cancer, such as MRI or ultrasound, are providing care that is inconsistent with these recommendations. Numerous studies have assessed how often women are receiving age-appropriate breast cancer screening, [18][19][20] and a national survey has assessed physician mammography and breast exam recommendations, 21 but to our knowledge, no previous study has examined how often physicians offer breast cancer screening via modalities other than mammography.…”

Using VA administrative data to measure colorectal cancer screening adherence among average-risk non-elderly veterans

“…Studies using administrative data (e.g., Medicare and Medicaid claims) showed that CRC screening rates varied from 25 to 47% in the late 1990s and also in the current decade (Cooper and Koroukian 2004;Cooper and Kou 2008;Ananthakrishnan et al 2007;Schneider et al 2008;DuBard et al 2008). Others, using survey data such as the National Health Interview Survey and the Behavioral Risk Factor Surveillance System, reported that rates for the U.S. general population ranged from 40 to 65% during the same period (Schneider et al 2008;Swan et al 2003;Liang et al 2006;Phillips et al 2007;CDC 2001).…”

Declining Mammography Screening in a State Medicaid Fee-for-Service Program: 1999–2008

“…57 These finding are in contrast with the results of another study examining breast cancer screening in North Carolina Medicaid recipients aged ‡ 50, in which white women were less likely to have been screened than African American women. 50 In this study, screening rates among women residing in nonmetro-rural areas were higher compared to women residing in metro-urban and nonmetro-urban areas. This result is in contrast to previous studies that have found lower screening rates among women residing in rural areas compared to those in urban areas.…”

“…Our results are consistent with previous studies, which also had demonstrated lower screening rates among women recipients enrolled in Medicaid programs. 50,57 Studies consistently have found lower screening rates among women with public health insurance, including those with Medicaid coverage, compared to those with private health insurance. 23,24,34,40 Annual and biennial screening rates were higher among white women compared to their counterparts from other racial groups (including African Americans).…”

“…40 A study of receipt of cancer screening in a Medicaid population reported a breast cancer screening rate of 31.8% in women aged ‡ 50 enrolled in the Medicaid FFS program, which is substantially lower than the average screening rate for women in the United States. 50 Evidence also suggests that breast cancer is diagnosed at a later stage among FFS enrollees than in HMO enrollees. 51 Given the nationally changing trends in screening and incidence of breast cancer, screening trends among low-income women represented in the FFS Medicaid program are important to ongoing breast cancer screening initiatives for improving screening behavior among underprivileged women in the United States.…”