Access to Preventive Health Care in Severely Disabled Women with Multiple Sclerosis

Abstract

Background: Nonambulatory patients may be at risk for poor access to preventive health screening. Few studies have reported on this access in severely disabled women with multiple sclerosis (MS). We sought to describe preventive medical care in the most disabled women with MS and to identify factors that may influence access to care.

Methods: Patient records from the Partners MS Center database were reviewed. Women with Expanded Disability Status Scale scores of 7 or greater were selected. Proportions of patients with preventive-care visits were compared with 2012 Centers for Disease Control and Prevention (CDC) guidelines and normative data. Logistic regression was used to assess demographic and disease effects on receiving services.

Results: Forty-eight percent of patients had annual mammograms versus 72% of healthy women and the CDC target of 81%; 41.8% had Papanicolaou smears within 3 years compared with 82% of healthy women and the target of 93%; and 61.2% aged 50 years and older ever had a colonoscopy compared with the target of 70%. Younger age predicted lower rates of colonoscopy (P < .002) and mammography (P < .004), and shorter disease duration predicted lower rates of mammography (P < .004). Obesity was associated with a lower likelihood of colonoscopy (P = .007) and bone density screening (P = .02).

Conclusions: Women with severe MS disability are vulnerable to significantly decreased access to preventive care. The influence of patient and physician factors and the possible consequent delays in cancer diagnosis should be further clarified.