Adherence to cervical cancer screening guidelines by family physicians in Calgary: cross-sectional analysis using demographic characteristics and lab data

Abstract

Background: The effectiveness of cervical cancer screening programs is well recognized; however, inappropriate screening practices result in either a woman being tested too often or not tested at the recommended intervals. The objectives of the study were to identify the characteristics of family physicians associated with over- and underscreening for eligible women aged 25-69 in Calgary, Alberta. Methods: We performed a population-based retrospective observational study linking the Calgary Laboratory Services database from 2014-2016 to the College of Physicians and Surgeons of Alberta database of family physicians practicing in Calgary. We matched physicians’ characteristics with their cervical screening practices. Panel size data was not directly available, so we used their laboratory test orders in 2016 as a proxy measure to estimate physician practice size. For the underscreening analysis, we excluded those physicians whose estimated practice size was lower than the number of screening tests ordered. Logistic regression models were applied to analyze the overscreening and underscreening patterns. Results: Among 807 physicians included in the overscreening analysis, 43% of physicians had over-screened their screen-eligible patients. Physician characteristics significantly associated with overscreening included more years of practice and having more female patients in the practice. Among the 317 physicians included in the underscreening analysis, 42% had under-screened during the three-year study period. Female physicians were less likely to underscreen their eligible female patients. Physicians practicing in the Northeast quadrant of the city also had higher odds of underscreening. Conclusions: Screening patterns of family physicians indicate both overuse and underuse, which indicates inconsistency in adherence to screening guideline recommendations. Addressing disparities and identifying strategies to improve guideline adherence among different physician demographic groups is critical for the success of screening programs.