Messages on healthy living found to miss many women

Washington -- Physicians are not taking advantage of all opportunities to counsel women patients about healthy behaviors, according to survey results released on July 7 by the Kaiser Family Foundation.

That finding becomes even more serious when coupled with responses from more than half of the 2,766 women surveyed last year that they are more likely to turn to their physicians for information rather than the Internet, family and friends, or books.

But cramming all of the necessary discussion items into a 15-minute exam is a difficult juggling act for many physicians, said a panel of experts assembled to discuss the survey.

For one thing, the all-important preventive health care conversation is not necessarily reimbursable under a patient's health plan, noted Alina Salganicoff, PhD, vice president and director of Women's Health Policy at the Kaiser Family Foundation. Providing physicians and others with the means to talk about these topics is an important goal, she said.

In addition, physician face time with patients is often consumed with helping patients gain access to affordable specialty care, said Susan Starr Sered, PhD, senior research associate at Suffolk University's Center for Women's Health and Human Rights in Boston.

Also, it takes a superorganized physician to make sure that patients have all of the necessary referrals for screenings before they leave the office, said Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality, describing her own races to beat her patients to the door.

Whatever the reason, fewer than half of all the 18- to 64-year-old women responding to the survey said they had talked to a physician or other health care professional in the past three years about such subjects as smoking cessation, alcohol use and abuse, and the need for adequate calcium intake. Just more than half said they had received advice about diet, exercise and nutrition.

Among women of reproductive age, fewer than one in three said they had talked in the past three years with their physicians about their sexual history and specific issues such as sexually transmitted diseases or HIV/AIDS.

The survey also found that, while a majority of women are in good health and satisfied with their care, many do have health problems and do not get an adequate level of preventive care. For women who are sick, poor or uninsured, the problems are magnified.

The foundation's national survey, "Women and Health Care: A National Profile," is based on telephone surveys and, for comparison, included a shorter survey of 507 men. It is a follow-up to one conducted by the foundation in 2001. Comparing the results of the two revealed that more women are delaying or forgoing medical care because of increasing costs.

Spiraling costs

More than one-quarter of insured women and two-thirds of uninsured women said they had delayed or gone without needed care during the previous year because they could not afford it, compared with 24% and 59% respectively in 2001.

"The growth in health care costs has become a central women's health issue," Dr. Salganicoff said. "A sizable share of women are falling through the cracks, either because they don't have insurance or, even with insurance, they can't afford to pay for medical care or prescription drugs."

Mammography rates for women ages 40 to 64 had also fallen slightly from 73% in 2001 to 69% in 2004. Pap smear testing rates fell from 81% in 2001 to 76% in 2004.

The lower mammography rate could be a sign of troubling trends in the radiology field that are building to crisis levels, said Paula Johnson, MD, MPH, chief of women's health at Brigham and Women's Hospital in Boston. There are too few qualified readers of mammograms, she said, an issue that is little recognized and in need of attention.

Dr. Clancy said she also had received reports from radiologists of low reimbursement rates and mounting regulations that are limiting access to mammograms, especially for low-income patients.

Dr. Sered noted that women have told her that they would often return to a clinic to repeat their annual mammograms only to find the clinic had shut down.

And if cancer is detected, treatment can be difficult to obtain, and costly. Women said they would rather not know that they had cancer if treatment were not available.

On the other hand, the declining rates of Pap tests could reflect a positive change, Dr. Clancy said. More women and physicians may be getting the updated message that not everyone needs a test every year.

The survey also uncovered surprisingly high levels of chronic illness among women of reproductive age. Nearly one-quarter of women ages 18 to 44 reported that they had a chronic condition requiring ongoing treatment, and one in 10 women reported having hypertension, high cholesterol, asthma or other respiratory problem.

Some of the contentious issues, including how physicians can undertake more preventive counseling, might be resolved as pay-for-performance activities take hold in medicine, Dr. Johnson said.

Some insurers already include checklists of issues for physicians to cover during exams and that could provide one route. But the question remains, she said, "How do we get the counseling done and paid for?"