The underuse of screening services among elderly women with diabetes
The underuse of screening services among elderly women with diabetes
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DOI：
10.2337/dc06-2233
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发表时间：
2007-06-01
期刊：
影响因子：
16.2
通讯作者：
Yu, Xinhua
中科院分区：
文献类型：
--
作者：
McBean, A. Marshall;Yu, Xinhua
目的：确定非糖尿病相关预防服务的使用是否研究设计和方法-使用美国老年女性人口的代表性样本和相关的监测、流行病学和最终结果（SEER），医疗保险文件，我们确定了1999年1月1日年龄≥ 67岁的患有或不患有糖尿病的妇女。所有有癌症病史的女性都被排除在外。采用双变量和多变量分析比较预防性服务的使用率，并了解未来2-4年影响其使用的因素。（比值比[OR] 0.83 [95%CI 0.78-0.881]）、结直肠癌筛查（0.79 [0.70-0.88]）和骨密度检测（0.63 [0.58-0.691]）。内分泌科医生诊断的糖尿病妇女骨密度检测率明显高于初级保健医生诊断的妇女。妇女看到由产科医生/妇科医生有最高的使用率的所有三个service.CONCLUSIONS -老年妇女糖尿病患者接受癌症和骨质疏松症筛查的可能性比妇女没有糖尿病。治疗这些患者的医生需要确保他们接受适合其年龄的所有推荐预防服务。可能需要额外的国家指导方针，基于实践的改进，以及针对那些最有可能无法获得这些服务的患者的患者教育，以实现平等。
OBJECTIVE - To determine whether the use of nondiabetes-related preventive services (mammography, colorectal cancer screening, and bone density testing) among elderly diabetic women is different from the use among nondiabetic women.RESEARCH DESIGN AND METHODS - Using a representative sample of the U S elderly female population and the linked Surveillance, Epidemiology, and End Results (SEER), Medicare files, we identified women with or without diabetes who were >= 67 years of age on 1 January 1999. All women with a prior history of cancer were excluded. Bivariate and multivariate analyses were used to compare the rates of preventive service use and to understand the factors influencing their use in the next 2-4 years.RESULTS - women with diabetes were less likely to have a mammogram (odds ratio [OR] 0.83 [95% CI 0.78-0.881), colorectal cancer screening (0.79 [0.70-0.88]), and bone density testing (0.63 [0.58-0.691). Women with diabetes seen by endocrinologists had significant higher rates of bone density testing than women seen by primary care physicians. Women see by obstetrician/gynecologists had the highest rates of use of all three services.CONCLUSIONS - Elderly women with diabetes are less likely to receive cancer and osteoporosis screening than women without diabetes. Physicians treating these patients need to assure that they receive all recommended preventive services appropriate for their age. Additional national guidelines, practice-based improvements, and patient education targeting those at greatest risk of not receiving these services may be needed to achieve parity.