Low-income minorities with complex chronic diseases and physical disabilities have difficulty accessing appropriate healthcare often resulting in suboptimal care. A survey was performed to determine the impact of cultural and socioeconomic factors on the quality of care for low-income minorities with multiple sclerosis (MS) enrolled in Independence Care System (ICS), a Medicaid long-term managed care plan. All 92 ICS members with a diagnosis of MS were surveyed on three aspects of their care: specialty contact, immunomodulating drug therapy and osteoporosis prevention. Of those surveyed, 32% were never seen by an MS specialist. One third were not taking immunomodulatory medications, primarily due to noncompliance caused by a lack of understanding about these drugs. The prevention of osteoporosis and potential fracture in this high-risk population was largely neglected by providers despite the fact that the majority of those surveyed also reported balance difficulties and a history of falling. The survey revealed several deficiencies in the care of low-income minorities with MS. A major issue was the lack of adequate education, particularly about the immunomodulating drugs. Education about the importance of osteoporosis prevention, falls mitigation programmes and rehabilitation evaluations are critical interventions to decrease the risk of fracture.

The health maintenance of women with diverse disabilities and chronic disabling conditions has been neglected by medical professionals. Interest in their basic health promotion has been eclipsed by the narrowed focus on their underlying conditions. We surveyed preventive medical practices of 220 women with multiple sclerosis (MS). The objectives of this study were to evaluate the adequacy of preventive healthcare delivery for women with MS and to explore the adequacy of the detection, prevention, and treatment of osteoporosis in this high-risk population. Our survey revealed that 50% of the women do not get regular medical preventive checkups. Twenty-five percent do not have regular pelvic examinations, and 11% have not had a Pap smear within 3-5 years. In women over 40 years old, 52% do not have yearly mammograms. Risk factors for premature osteoporosis in our sample included impaired mobility (53%), corticosteroid use (82%), and vitamin D deficiency as a result of avoidance of sunlight. Despite these risks, 85% have never had bone density testing, 50% are not taking calcium supplements, and 71% are not taking vitamin D. Among the postmenopausal sample, 81% have never had bone density testing, 50% are not taking calcium supplements, and 70% are not receiving hormone replacement therapy (HRT). Only 1% are taking bone resorption inhibitors. The benefits of preventive healthcare and cancer prevention screening should be stressed to women with MS. Referrals should be facilitated by neurologists for dignified, knowledgeable examinations in fully accessible facilities. Osteoporosis prevention, screening, and treatment protocols must be part of the medical plan for all women with MS.

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