Variations in Practice Guideline Adherence for Abnormal Cervical Cytology in a County Healthcare System

Abstract

BACKGROUND: Reduction in cervical cancer incidence and mortality is not only dependant on promoting cervical cancer screening but also on providing appropriate follow-up and treatment of abnormal cervical cytology. OBJECTIVES:The objective of this study was to determine variations in guideline adherence for women requiring abnormal cervical cytology follow-up. SUBJECTS:Subjects of the study are women 18 years or older with an abnormal Pap test in 2000 within a large county healthcare system (n=8,571). MEASUREMENTS:Guideline adherence was determined by the presence or absence of the appropriate follow-up procedure within an acceptable time interval for each degree of cytological abnormality. Patients with no follow-up studies were deemed to be lost to follow-up. RESULTS:Of study subjects, 18.5% were lost to followup care. Of the remaining 6,987 women, 60.3% received optimal care, 9.4% received suboptimal care, and 30.3% received poor care. Follow-up rates were higher for patients with higher degree of cytological abnormality (OR, 1.29, 95% CI, 1.17-1.42), older patients (OR, 1.03, 95% CI, 1.02-1.030) and those receiving the index Pap test at a larger healthcare facility (OR, 1.13; 95% CI, 1.01-1.27). Receiving optimal care was positively correlated with higher degree of cytological abnormality (p<.0001) and larger facility size (p=.002). Regional variations in care demonstrated the largest cluster having the lowest lost to follow-up rate and the most optimal care. CONCLUSIONS: A significant number of women with abnormal cervical cytology are receiving less than optimal care. Further studies are required to determine the specific healthcare delivery practices that need to be targeted to improve guideline adherence for follow-up of abnormal cytology.

Automated Recommendation for Cervical Cancer Screening and Surveillance

“… 20 , 26 The three-year interval is also inappropriate for patients with abnormal cytology or other risk factors. 27 , 28 Decision making for the high-risk patients requires interpretation of free-text pathology and clinical reports, and existing CDS systems generally lack the capability to interpret free-text reports and cannot supply appropriate recommendations for high-risk patients. 25 , 29 Paradoxically, providers require greater support in order to optimally manage high-risk patients.…”

Cervical Smears at Public Health Centres in Eastern Trinidad: Coverage and Follow-up, 2009–2010

“…Dzuba et al also reported from Bolivia that 50% to 80% of women with abnormal cervical smears were lost to follow-up (16). A similar study by Singhal et al in the United States of America (USA) found that a significant proportion of women were not receiving the care as recommended (6).…”

“…C Whether the client returned for the results of the cervical screening C Whether the client was recommended for a repeat Pap smear C Whether the client followed-up on the request for a repeat Pap smear C Whether the client was recommended for a gynaecological evaluation C Whether the client followed-up on the recommendation for gynaecological evaluation C Description of the client's follow-up care, ie optimal, suboptimal or poor [defined below (6)] C Details of client's demographic data, age, ethnicity, union status, educational level and household income The definition of optimal care is care based on the recommended schedule for an abnormal smear, ie for lowgrade lesions or human papillomavirus (HPV), repeat Pap smear within six to eight months; for high-grade lesions, referral for gynaecological evaluation within six weeks of receipt of abnormal results (6). Suboptimal care means that the woman had follow-up care but not according to the recommended schedule as stated above.…”

“…Suboptimal care means that the woman had follow-up care but not according to the recommended schedule as stated above. Poor care means that the woman did not follow-up on the recommended schedule for care (6).…”

“…The major concerns are inadequate coverage of the target population and poor follow-up of women with abnormal cervical smears (6,7). In light of this situation, technical experts have recommended regular monitoring of core indicators such as coverage of target population and follow-up of women with positive screening results in order to implement effective programmes to achieve the goal of cervical screening (8).…”