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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Sean Schafer, MD1, Norman Hearst, MD, MPH2, Judith T. Gonzalez-Calvo, PhD3, Helda Lucia Pinzon-Perez, PhD, CHES4, Lisa Chaney, RN5, and Vickie D. Krenz, PhD, MSPH4. (1) UCSF-Fresno Medical Education Program, Family Medicine Residency Program, University Medical Center, 445 S. Cedar Ave., Fresno, CA 93702, 559-459-5705, schafer@ucsfresno.edu, (2) Family & Community Medicine, University of California- San Francisco, University of California San Francisco, 500 Parnassus Ave, MU-337E, San Francisco, CA 94143-0900, (3) Sociology Department, California State University Fresno, 5340 N. Campus Dr., M/S SS 107, Fresno, CA 93740, (4) Department of Health Science, California State University, Fresno, 2345 East San Ramon Ave, M/S MH 30, Fresno, CA 93740, (5) Madera Unified School District, Fresno, Fresno, CA 93740
Background: Papanicolau (Pap) smear rates have been 15 to 30% lower and cervical cancer rates up to three times higher among Latinas compared with non-Hispanic whites. Managed care Medicaid programs were introduced to control costs and improve access for poor and underserved populations. It is not clear whether delivery of Pap smears has increased for Latinas enrolled in managed Medicaid. Objective: To measure the proportion of a population of immigrant Latinas enrolled in managed Medicaid who have had a Pap within 3 years. Design: Cross-sectional review of medical records. Participants: 712 women with Hispanic surnames, aged 18 to 65, from Fresno County, CA, enrolled in managed Medicaid on February 1, 2001, at three large community health centers serving largely immigrant, farmworker populations. Results: Of 712 participants, 360 (51%) had clear evidence of having been seen in the health center to which they were assigned. Excluding 43 women with hysterectomy (17) or prior abnormal Pap smear (26), 225 of 317 (71%) had a documented Pap within 3 years. Having received prenatal services and having a clearly identified method of contraception (p<0.001) were associated with receiving a Pap. If women for whom no record was located are assumed not to have had a Pap smear, the estimated Pap rate is only 34% (225 of 669). Conclusions: Despite enrollment in managed Medicaid, Latinas continue to experience low Pap rates. The main barrier seems to be that almost half of these women are never seen at the clinics to which they are assigned.
Learning Objectives:
Keywords: Medicaid Managed Care, Latino Health
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.