Patricia A. Findley

Women With Disabilities’ Experience With Physical and Sexual Abuse Review of the Literature and Implications for the Field

While studies suggest that the rate of abuse of women with disabilities is similar or higher compared to the general population, there continues to be a lack of attention to this issue. Women with disabilities are at particularly high risk of abuse, both through typical forms of violence (physical, sexual, and emotional) and those that target one’s disability. In an effort to highlight the need for increased attention to this issue, this article reviews the current peer-reviewed research in this field. The authors outline recommendations for future research goals and provide implications for research, practice, and policy.

Health Care Expenditures of Living With a Disability: Total Expenditures, Out-of-Pocket Expenses, and Burden, 1996 to 2004

OBJECTIVE To estimate the health care expenditures associated with a disability and their recent trends. DESIGN Retrospective analysis of survey data. SETTING Not applicable. PARTICIPANTS Data from multiple years (1996-2004) of the Medical Expenditure Panel Survey (MEPS) for a nationally representative sample of civilian, noninstitutionalized U.S. population. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Health care expenditures consisted of total health care expenditures, total out-of-pocket (OOP) spending, and burden (the ratio of OOP to family income). All the analyses accounted for the complex survey design of the MEPS. RESULTS Between 1996 and 2004, 6% to 9% of persons in the working-age group (21-61 y) were identified as having a disability. Persons with disabilities consistently had higher total health expenditures, OOP spending, and burden compared with their counterparts without disabilities. In 2004, the average total expenditures were estimated at

Preventive health services and lifestyle practices in cancer survivors: a population health investigation

10,508 for persons with disabilities and at

Are there Gender Differences in Diabetes Care Among Elderly Medicare Enrolled Veterans

2256 for those without disabilities. In a multiple regression framework, persons with disabilities were consistently found to have higher expenditures, OOP spending, and burden between 1996 and 2004. Although expenditures, OOP spending, and burden increased over time, after controlling for demographic, socioeconomic, and health status, these 3 health care costs were not found to change disproportionately for persons with disability. CONCLUSIONS During the 1996 to 2004 period, persons with disabilities were consistently found to have significantly higher health expenditures, OOP spending, and burden compared with their counterparts without disabilities, which may adversely affect their health and standard of living.

Co-occurring medical and mental illness and substance use disorders among veteran clinic users with spinal cord injury patients with complexities

IntroductionLong term health in cancer survivors require both preventive health services and certain health behavior practices in order to prevent the major chronic diseases that can occur for any adult in the general population. Despite this we currently do not know the pattern of clinical preventive services and health behaviors of cancer survivors in the US population. The present study examines the patterns of preventive health activities in two domains: clinical preventive services and healthy lifestyle practices in a heterogeneous population of cancer survivors.MethodsLongitudinal analyses of Medical Expenditure Panel Survey (MEPS) data, a nationally representative health survey, for the calendar years 2000 through 2004 were conducted. Cancer survivors were defined as individuals diagnosed with cancer in the baseline year and alive in the subsequent year. To address both provider based and behavioral health activities, two categories of care were included: clinical preventive services consisting of influenza immunization, routine physical examination, and a dental check up within the last year using the follow-up year data and healthy lifestyle practices including engaging in moderate/vigorous exercise three times per week, maintaining a body mass index (BMI) within normal range, and not currently smoking. Chi-square tests and Poisson regressions were performed to identify factors that were associated with these preventive health activities.ResultsUnadjusted rates of preventive health activities were as follows: 78% had a routine physical check up, 66% visited the dentist at least annually, and 54% received an influenza immunization. Across healthy lifestyle practices, 80% did not smoke, 52% engaged in regular exercise, and 37% maintained their BMI within normal range. Only 31% received all three clinical preventive services and only 16.5% engaged in all three healthy lifestyle practices. Across both domains of preventive health activities, age, marital status, and education were positively associated with the number of services. Presence of diabetes and poorer mental health were associated with greater number of clinical preventive services and lower number of healthy lifestyle practices. Cancer survivors with fair/poor perception of their mental health had lower number of clinical preventive services and those with fair/poor perception of physical health engaged in lower number of healthy lifestyle practices. Demographic and health status factors impacted the two domains differentially.Discussion/ConclusionsThe rates and predictors of preventive care varied by type of service/domain suggesting that individualization is needed in creating a comprehensive preventive service and lifestyle activity plan that accounts for the survivor’s specific total care needs, including all comorbidities. However, it was also found that cancer survivors are less likely to engage in all types of preventive activities; a one-size-fit-all approach is not recommended for preventive health education and planning for this population.Implications for cancer survivorsOur study findings suggest the need to address the overall long term healthcare of cancer survivors by prioritizing and developing individualized preventive plans to optimize care that emphasize education, self care perceptions, and incorporate other comorbidities.

Employment and Disability: Evidence From the 1996 Medical Expenditures Panel Survey

AbstractOBJECTIVE: To examine gender differences in diabetes care process measures and intermediate outcomes among veteran clinic users. DESIGN: A retrospective cohort study using Veterans Health Administration (VHA) and Medicare files of VHA clinic users with diabetes. Diabetes care process measures were tests for hemoglobin A1c (HbA1c), low-density lipoprotein (LDL-C) values, and eye exams. Intermediate outcomes were HbA1c and LDL-C values below recommended thresholds. Chi-square tests and logistic regressions were used to assess gender differences. PARTICIPANTS: Study population included 3,225 women and 231,922 men veterans with diabetes, enrolled in Medicare fee-for-service and alive at the end of fiscal year 2000. RESULTS: Overall, there were no significant gender differences in HbA1c or LDL-C testing. However, women had higher rates in these process measures than men among the non-African American minorities. Women were more likely to have completed eye exams (odds ratio [OR]=1.11; 99% confidence interval [CI]=1.10, 1.23) but were less likely to have LDL-C under 130 mg/dL (OR=0.77; 99% CI=0.69, 0.87). CONCLUSIONS: Among VHA patients with diabetes, clinically significant gender inequality was not apparent in most of diabetes care measures. However, there was evidence of better care among nonwhite and non-African American women than their male counterparts. Further research on interaction of race and gender on diabetes care is needed. This includes evaluation of integrated VHA women’s health programs as well as cultural issues. Lower LDL-C control among women suggests areas of unmet needs for women and opportunities for future targeted quality improvement interventions at system and provider levels.

Disparities in Preventive Care by Body Mass Index Categories Among Women

Study design:Longitudinal analysis of SCI registry merged with VHA administrative-data and Medicare claims files (FY1999–2002).Objectives:To estimate the prevalence of mental illness (MI) and substance use disorders (SUDs) among veteran health administration (VHA) clinic users with spinal cord injuries (SCI) and examine subgroup variations by demographic, socioeconomic characteristics, and duration and level of SCI.Setting:VHA clinic users (N=8338) with SCI who were alive by the end of FY2002.Methods:ICD-9-CM codes were used to identify individual MI (anxiety disorders, bipolar, depressive disorders, psychoses, post-traumatic stress disorder (PTSD) and schizophrenia) and categories of SUDs (tobacco, alcohol and drug abuse). Chi-square tests and multinomial logistic regression were used to examine the demographic and socio-economic profile of VHA users with SCI and MI and/or SUD.Results:Over a 2-year period, 46% VHA users with SCI had either a MI or SUDs: 20% had MI only; 12% had SUD only and 14% had both. The most common MI was depressive disorder (27%) and tobacco use was highly prevalent (19%). African-Americans (versus whites) were less likely to be diagnosed with MI only. Increased duration of SCI lowered the likelihood of MI and/or SUDs. Mood and anxiety disorders were highly prevalent in veterans with SCI with chronic physical conditions such as diabetes, heart disease, hypertension, and respiratory diseases.Conclusions:Mental illness and SUDs are highly prevalent in the VHA population with SCI and is complicated by the high rates of chronic physical conditions, presenting challenges in their healthcare management

Depressive disorders among cohorts of women veterans with diabetes, heart disease, and hypertension.

The relationship between employment and disability has gained national attention, as the ability to maintain employment is inconsistent among those with limitations. This cross-sectional study of employment among individuals (N= 1691, age 21–62 years) with self-reported limitations in the 1996 Medical Expenditures Panel Survey seeks to identify predictors of employment despite physical and/or cognitive limitations. Two predictive models of employment including 10 variables are explored; 1 included insurance (χ2 =3856.85, p ≤ 0.00) and the other removed the insurance variable (χ2 =280.21, p ≤ 0.00). Individuals with limitations who are employed are more likely to have a college-level education, have better physical and mental health perceptions and have private insurance. This analysis demonstrates that people do work despite reported activity, functional or sensory limitations and that socioeconomic factors are crucial in why someone is able to attain employment.

Initial nontraumatic lower-extremity amputations among veterans with diabetes.

ABSTRACT Objective: The present analyses examined the relationship of body mass index (BMI) categories to receiving age-appropriate preventive services among women. Method: Data from the Medical Expenditure Panel Survey (2003, N = 10,954) were analyzed using multiple logistic regressions. Outcomes were: age-appropriate Pap-test, mammography, colorectal, cholesterol and blood pressure screening, and influenza immunization. Results: Overall, 3% of participants were underweight, and 26.3% were obese. Obese women were less likely to receive Pap-tests (p < .01), and underweight women less likely to receive mammography (p < .001). Dental care was less likely across all BMI groups outside the normal weight range. Conclusions: The association between BMI categories and preventive services use varied by type of preventive care.

Social work practice in the chronic care model: Chronic illness and disability care

OBJECTIVES To compare the rates of major and minor depression in cohorts of women veterans with diabetes or heart disease or hypertension and examine variations in these rates by demographic, socioeconomic, and health status among these women. METHODS This was a retrospective cross-sectional analysis of fiscal year 2002 and 2003 data on 13,430 women veterans with diabetes or heart disease or hypertension who were diagnosed with depression and used Veteran Health Administration (VHA) clinics. International Classification of Diseases, 9th ed. Clinical Modification codes from merged VHA and Medicare claims files were used to identify diabetes, heart disease, hypertension, and depression. Chi-square tests and multinomial logistic regressions were used to characterize women veterans with major and minor depression. RESULTS Of all the women veterans diagnosed with diabetes or heart disease or hypertension and using the VHA clinics, 27% were diagnosed with depression. Of these 13,430 women with any depression, 60% were diagnosed with minor depression and 40% had major depressive disorders (MDD). Compared to major depression, minor depression was significantly more likely among women veterans who were older, without any other psychiatric condition and substance use disorders. CONCLUSIONS Minor depression is highly prevalent among women veterans with complex chronic illness, such as diabetes or heart disease or hypertension (i.e., women at risk or with cardiovascular conditions), suggesting a need to closely monitor these women to reduce the risk of major depression. Some subgroups of women were more likely to have minor depression than major depression; studies that exclusively focus on major depression will selectively miss these subgroups of women veterans.