External audit of providers of the Cervical Cancer Prevention Programme in Poland in 2016/2017

Abstract

Introduction. The Cervical Cancer (CC) Prevention Programme includes 3 phases: basic (Pap smear collection), diagnostic (Pap smear evaluation) and in-depth (colposcopy/biopsy in case of abnormal smear test findings). The Programme service providers are subject to an external audit and this publication's objective is to analyse its results from 2016 and the first half of 2017. Materials and methods. The audit of the Programme performance in the period 01.01.2016-30.06.2017 was carried out by external auditors by way of personal visits to the offices of the service providers and by way of direct data retrieval. The audit covered 12% (198) of the basic phase, 100% (66) of the diagnostic phase and 100% (62) of the in-depth phase facilities. The Polish National Health Fund (NHF) did not make available the routinely collected data for the purpose of audit. Audit data collected in the developed protocols were analysed. Results. The number of Pap smears (2,028,988) and the number of colposcopies (13,636) outside the Programme was, respectively, more than two and three times higher than in the Programme (cytology-801,640, colposcopy-3929). The performance of the procedures (Programme vs outside the Programme) was highly variable depending on the provider. The percentage of Pap smears unsuitable for evaluation did not differ significantly between gynaecologists and midwives. All audited cytological laboratories carried out rescreening of samples. Biopsy was not performed in 11% (2016) and 15% (2017) of colposcopy laboratories. Inaccuracies were found in 19% (61) of the audit protocols. Discussion. Significantly higher number of procedures performed outside the Programme results from lower renumeration of procedures within the Programme. Variable provider's preferences in the mode of procedures execution indicates that with the use of appropriate organisational solutions it would be possible to reduce opportunistic screening, which is of unknown quality. The quality of Pap smear sample collection in the case of gynaecologists and midwives is the same, but the number of primary care provider (PCP) facilities where midwives collect smears is very limited. The inaccuracies noted in the audit protocols indicate that the lack of access to data collected by the National Health Fund decreased the quality of the audit carried out and the reliability of the data obtained. Conclusions. Restoring full access to data collected by the NHF is crucial for the Programme audit quality. Measures should be implemented to reduce opportunistic screening and shift the stream of tests to the Programme (both at the basic and at the in-depth phase), and to increase the availability of tests in PCP facilities through training for midwives.

Secondary prevention and treatment of cervical cancer - update from Poland

“…This is a negative connotation since the number of lesions requiring further diagnostics detected in cervical cytology correlates strongly with numbers of patients tested in outpatient specialty care (AOS) and the percentage of the national population covered by the screening program. In addition, Turkot et al, in their 2018 audit of cytology laboratories in Poland, found there was a significant increase in Pap testing outside the national healthcare program, that is, in the private healthcare sector [11]. Both our results and those of the authors mentioned above may suggest that Pap smear tests are performed in private healthcare.…”

Liquid-Based Screening Tests Results: HPV, Liquid-Based Cytology, and P16/Ki67 Dual-Staining in Private-Based Opportunistic Cervical Cancer Screening

“…Its exact screening coverage remains unknown, but published questionnaire data suggest a significant percentage of involvement. In 2012, the participation of Polish women in screening outside of the program was 1.7 times higher than in the program [4,8], and in the last 3 years, about 70% of women have had a Pap test [9], which clearly suggests the dominating role of the private-based screening. There are various models in Polish private-based screening, from cytology to cotesting; the latter was approved in 2013 [10].…”