When researchers reviewed medical records for Medicaid-insured people over 50, they found that only about half had colorectal cancer screening recommended to them by their doctors. But only 28 percent actually received screening.
Having an on-going relationship with a doctor (medical home) made a difference. People who had been seeing their primary care doctor for more than five years were two and a half times more likely to have been screened.
The North Carolina Division of Medical Assistance, the state agency responsible for Medicaid in North Carolina, reviewed the records of patients over 50 kept by their primary care doctors. They found that many patients were not being offered screening for colorectal, breast, and cervical cancer and fewer were actually getting the tests.
- For colorectal cancer, 52.7 percent of patients were offered screening, 28.2 were tested.
- 60.4 percent of women were sent for mammograms, 31 percent got the exams.
- Pap smears were recommended to 51.5 of eligible women, but 31.6 percent actually were tested.
Like colorectal cancer screening, women with a stable, long-term relationship with their doctor were more than twice as likely to have receive mammograms. The study authors wrote,
This finding underscores the value of a stable medical home in achieving national objectives for receipt of preventive services.
The researchers also pointed out that all patients in the study had access to primary health care and payment for screening, including colonoscopy. Almost all of the patients (80 percent) who got colorectal screening got it via colonoscopy.
C. Annette DuBard M.D. M.P.H. and her colleagues concluded,
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.
SOURCE: DuBard et al. Archives of Internal Medicine, Volume 168, Number 18, October 13, 2008.