Cervical cancer screening and acute care visits among Medicaid enrollees with mental and substance use disorders.

OBJECTIVE This study compared rates of cervical cancer screening and acute care (primary or gynecological) visits among women with and without a diagnosis of psychosis, substance use disorder, bipolar disorder or mania, or depression. METHODS Using data about women (N=105,681) enrolled in Maryland's Medicaid program in fiscal year 2005, the authors constructed logistic models with cancer screening and acute care visits as dependent variables and serious mental illness flags as independent variables. Covariates were age, race, geography, Medicaid eligibility category, and sexually transmitted diseases. The logistic model of cervical cancer screening outcomes was repeated with acute care visits as a covariate. RESULTS Women with psychosis (N=4,747), bipolar disorder or mania (N=3,319), or depression (N=5,014) were significantly (p<.05) more likely than women in a control group without such disorders (N=85,375) to receive cancer screening (adjusted odds ratio (AOR) range=1.46-1.78) and to have associated acute care visits (AOR range=1.45-2.15). Compared with those in the control group, women with a substance use disorder, with (N=1,104) or without (N=6,122) psychosis, demonstrated reduced odds of cancer screening (AOR=.80) but similar odds of acute care visits (AOR=1.04). Acute care visits were strongly correlated with cancer screens. Genital cancer prevalence did not significantly differ among diagnostic groups. CONCLUSIONS In Maryland Medicaid, the odds of cancer screening and related acute care visits were greater for women with major mental disorders compared with women in the control group. For women with substance use disorders, however, screening was reduced and acute care visits were similar compared with women in the control group. Providers should encourage and support their patients with substance use disorders to increase use of preventive care services by primary care physicians and gynecologists.

[1]  Quality,et al.  National Healthcare Disparities Report , 2014 .

[2]  P. Cram,et al.  Mentally ill Medicare patients less likely than others to receive certain types of surgery. , 2011, Health affairs.

[3]  P. Darney,et al.  Correlates of Receiving Reproductive Health Care Services Among U.S. Men Aged 15 to 44 Years , 2011, American journal of men's health.

[4]  Harold Alan Pincus,et al.  Can Psychiatry Cross the Quality Chasm? Improving the Quality of Health Care For Mental and Substance Use Conditions , 2011 .

[5]  D. Kelly,et al.  The impact of substance abuse on osteoporosis screening and risk of osteoporosis in women with psychotic disorders , 2011, Osteoporosis International.

[6]  A. Lofters,et al.  Are women with psychosis receiving adequate cervical cancer screening? , 2010, Canadian family physician Medecin de famille canadien.

[7]  H. Chochinov,et al.  Are cervical cancer screening rates different for women with schizophrenia? A Manitoba population-based study , 2009, Schizophrenia Research.

[8]  H. Chochinov,et al.  Does a diagnosis of schizophrenia reduce rates of mammography screening? A Manitoba population-based study , 2009, Schizophrenia Research.

[9]  A. Mitchell,et al.  Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies , 2009, British Journal of Psychiatry.

[10]  Heidi L Gullett,et al.  Cervical cancer screening and updated Pap guidelines. , 2009, Primary care.

[11]  Linda Rosenberg Msw.  Health Care Homes to Meet the Unique Needs of Persons with Serious Mental Illness , 2009, The Journal of Behavioral Health Services & Research.

[12]  A. Steptoe,et al.  Psychiatric hospital admissions, behavioral risk factors, and all-cause mortality: the Scottish health survey. , 2008, Archives of internal medicine.

[13]  A. Tucker,et al.  A Framework for State‐Level Analysis of Duals: Interleaving Medicare and Medicaid Data , 2008 .

[14]  L. Howard,et al.  The needs of mothers with severe mental illness: a comparison of assessments of needs by staff and patients , 2008, Archives of Women's Mental Health.

[15]  G. Tao,et al.  Missed Opportunities for Chlamydia Screening of Young Women in the United States , 2008, Obstetrics and gynecology.

[16]  MSc Caroline P. Carney MD,et al.  The influence of type and severity of mental illness on receipt of screening mammography , 2008, Journal of General Internal Medicine.

[17]  A. Reece.  Lifetime prevalence of cervical neoplasia in addicted and medical patients , 2007, The Australian & New Zealand journal of obstetrics & gynaecology.

[18]  W. Fisher.  Better but Not Well: Mental Health Policy in the United States Since 1950 , 2007 .

[19]  S. Friedman,et al.  Incidence and prevalence of intimate partner violence by and against women with severe mental illness. , 2007, Journal of women's health.

[20]  I. Jatoi,et al.  Breast, colorectal, and skin cancer screening practices and family history of cancer in U.S. women. , 2007, Journal of women's health.

[21]  R. Frank,et al.  Better But Not Well: Mental Health Policy in the United States since 1950 , 2006 .

[22]  B. Druss,et al.  Improving general medical care for persons with mental and addictive disorders: systematic review. , 2006, General hospital psychiatry.

[23]  Sharon Larson,et al.  Preventive health examinations: a comparison along the rural-urban continuum. , 2006, Women's health issues : official publication of the Jacobs Institute of Women's Health.

[24]  M. White,et al.  Predictors of physical functioning among adults with severe mental illness. , 2006, Psychiatric services.

[25]  E. Chipps,et al.  Use of general medical services among Medicaid patients with severe and persistent mental illness. , 2005, Psychiatric services.

[26]  C. Schoen,et al.  Churn, churn, churn: how instability of health insurance shapes America's uninsured problem. , 2003, Issue brief.

[27]  U. P. S. T. Force,et al.  Screening for cervical cancer: recommendations and rationale. , 2003, American family physician.

[28]  J. Swanson,et al.  Gender differences in hepatitis C infection and risks among persons with severe mental illness. , 2003, Psychiatric services.

[29]  E. Perese,et al.  Health Problems of Women with Severe Mental Illness , 2003, Journal of the American Academy of Nurse Practitioners.

[30]  E. Yano,et al.  Use of general medical services by VA patients with psychiatric disorders. , 2002, Psychiatric services.

[31]  R. Drake,et al.  Medical morbidity, mental illness, and substance use disorders. , 2002, Psychiatric services.

[32]  B. Druss,et al.  Quality of medical care and excess mortality in older patients with mental disorders. , 2001, Archives of general psychiatry.

[33]  L. Dixon,et al.  Co-occurring severe mental illness and substance use disorders: a review of recent research. , 1999, Psychiatric services.

[34]  J. Santiago,et al.  Health care utilization by persons with severe and persistent mental illness. , 1999, Psychiatric services.

[35]  G. Huba,et al.  Level of burden among women diagnosed with severe mental illness and substance abuse. , 1999, Journal of psychoactive drugs.

[36]  M. Alexander.  Women with co-occurring addictive and mental disorders: an emerging profile of vulnerability. , 1996, The American journal of orthopsychiatry.