Survey shows women lag in getting preventive services


September 14, 1993|By Dr. Genevieve Matanoski | Dr. Genevieve Matanoski,Contributing Writer

Do women get all the preventive services they should? How do women feel about the health care they get? Recently, a large, national survey was conducted by Louis Harris and Associates Inc. for the Commonwealth Fund to try to answer some of these questions about women's health care. The survey was done by telephone and more than 2,500 women and 1,000 men over 18 were questioned.

The survey results make two clear points -- women are not getting all the preventive services they need, and women and their health-care providers often have communication problems.


Q: What did this survey tell us about preventive care for women?

A: I asked my colleague Dr. Carol Weisman, who worked with the Commonwealth Fund on the survey, this question. She notes that 44 percent of the women surveyed aged 50 and over had not had a mammogram in the past year even though the national guidelines recommend they have them annually.

Among all the women surveyed, 35 percent had not had a Pap smear to detect cervical cancer in the last year; 33 percent had DTC not had a clinical breast exam and 39 percent had not had a complete physical exam. It is generally recommended that women receive Pap smears and clinical breast exams annually.

Q: Why don't women get preventive care?

A: According to Dr. Weisman, the survey shows that one of the main reasons is money. When asked why they had not gotten preventive care, the women most often responded that the cost of the test was the reason.

Of the women who had health insurance coverage, 20 percent said that their insurance did not cover preventive services.

Women who were members of health maintenance organizations HMOs) were slightly more likely than other women to receive preventive services.

Of those women who said they had not received preventive services in the past year, 23 percent also said their physicians had not suggested they get such services.

Q: What initiatives do women take to help themselves stay healthy?

A: The survey shows women often don't practice prevention even when they don't need a physician to do so. Although regular exercise like walking helps prevent heart disease and osteoporosis, only 31 percent of women reported that they exercise three or more times a week. More women than men never exercise. One out of four women smoked. Although calcium supplements are considered an important measure to prevent osteoporosis, 70 percent of the women said they did not take these supplements.

Q: How did women describe their communications with their health-care providers?

A: The answers women gave to some of the questions suggest there are communications gaps between women and their doctors. About one quarter of the women said they had been "talked down to" or treated like a child by a physician. Seventeen percent of the women said they had been told by a doctor that a medical condition they felt they had was "all in their head." One out of every 10 women had had a problem or need that she did not discuss with her doctor because she felt uncomfortable or believed her doctor would be uncomfortable discussing it.

Q: What can be done?

A: We need to learn more about women's health needs and preferences and their experiences with health-care providers. The Commonwealth survey gives us a good start, but it is only that -- a beginning.

We need to understand better why women aren't getting the preventive care they should and what we can do to support women's preventive health care. And, we need to understand how women and their health-care providers can improve the communication process.

Preventive health-care is important for women. If you smoke, stop. Exercise at least three times a week. Every woman over 50 should have a mammogram annually. Every woman, from the age of her first sexual activity, should have an annual Pap smear to detect early cervical cancer and its precursors.

And, women need to work toward being more assertive within the health-care system.

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