Variations in Practice Guideline Adherence for Abnormal Cervical Cytology in a County Healthcare System
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
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.
The objective of this study was to determine variations in guideline adherence for women requiring abnormal cervical cytology follow-up.
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).
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.
Of study subjects, 18.5% were lost to follow-up 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.
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.
- American Cancer Society. Cancer Facts and Figures, 2006. Atlanta, Georgia: American Cancer Society; 2006.
- Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Mortality, Total US (1969–2002). National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch.
- Liu T, Wang X, Waterbor JW, Weiss HL, Soong SJ. Relationships between socioeconomic status and race-specific cervical cancer incidence in the United States, 1973–1992. J Health Care Poor Underserved. 1998;9:420–32.
- Herrero R. Epidemiology of cervical cancer. J Natl Cancer Inst Monogr. 1996:1–6.
- Lawson HW, Henson R, Bobo JK, Kaeser MK. Implementing recommendations for the early detection of breast and cervical cancer among low-income women. MMWR Recomm Rep. 2000;49:37–55.
- Lawson HW, Lee NC, Thames SF, Henson R, Miller DS. Cervical cancer screening among low-income women: results of a national screening program, 1991–1995. Obstet Gynecol. 1998;92:745–52. CrossRef
- Ries LA, Wingo PA, Miller DS, et al. The annual report to the nation on the status of cancer, 1973–1997, with a special section on colorectal cancer. Cancer. 2000;88:2398–424. CrossRef
- Liu L, Zhang J, Deapen D, Bernstein L, Ross R. Cancer in Los Angeles County: Incidence and Mortality by Race/Ethnicity 1988–2002. Los Angeles County Cancer Surveillance Program, University of Southern California. Available at http://www.usc.edu/schools/medicine/departments/preventive_medicine/divisions/epidemiology/research/csp/assets/pdf/cila8802_full.pdf. Accessed on January 18, 2008.
- Ries LA, Eisner M, Kosary C, et al. SEER Cancer Statistics Review, 1975–2002. National Cancer Institute. Bethesda, Maryland. Available at: http://seer.cancer.gov/csr/1975_2002/. Accessed on January 18, 2008.
- Patient Assessment Survey. Los Angeles, CA: Los Angeles County Department of Health Services/UCLA, 1999.
- Kaplan CP, Bastani R, Belin TR, Marcus A, Nasseri K, Hu MY. Improving follow-up after an abnormal pap smear: results from a quasi-experimental intervention study. J Womens Health Gend Based Med. 2000;9:779–90. CrossRef
- Marcus AC, Crane LA, Kaplan CP, et al. Improving adherence to screening follow-up among women with abnormal Pap smears: results from a large clinic-based trial of three intervention strategies. Med Care. 1992;30:216–30. CrossRef
- Marcus AC, Kaplan CP, Crane LA, et al. Reducing loss-to-follow-up among women with abnormal Pap smears. Results from a randomized trial testing an intensive follow-up protocol and economic incentives. Med Care. 1998;36:397–410. CrossRef
- Michielutte R, Diseker RA, Young LD, May WJ. Noncompliance in screening follow-up among family planning clinic patients with cervical dysplasia. Prev Med. 1985;14:248–58. CrossRef
- Benard VB, Lee NC, Piper M, Richardson L. Race-specific results of Papanicolaou testing and the rate of cervical neoplasia in the National Breast and Cervical Cancer Early Detection Program, 1991–1998 (United States). Cancer Causes Control. 2001;12:61–8. CrossRef
- Wright TC Jr., Cox JT, Massad LS, Twiggs LB, Wilkinson EJ. 2001 Consensus guidelines for the management of women with cervical cytological abnormalities. JAMA. 2002;287:2120–9. CrossRef
- Kurman RJ, Henson DE, Herbst AL, Noller KL, Schiffman MH. Interim guidelines for management of abnormal cervical cytology. The 1992 National Cancer Institute Workshop. JAMA. 1994;271:1866–9. CrossRef
- Solomon D, Davey D, Kurman R, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002;287:2114–9. CrossRef
- Cancer Trends Progress Report - 2007 Update. National Cancer Institute, NIH, DHHS. Bethesda, MD. Available at http://progressreport.cancer.gov. Accessed on January 18, 2008.
- Sharpless KE, Schnatz PF, Mandavilli S, Greene JF, Sorosky JI. Lack of adherence to practice guidelines for women with atypical glandular cells on cervical cytology. Obstet Gynecol. 2005;105:501–6.
- Noller KL, Bettes B, Zinberg S, Schulkin J. Cervical cytology screening practices among obstetrician-gynecologists. Obstet Gynecol. 2003;102:259–65. CrossRef
- Smith-McCune K, Mancuso V, Contant T, Jackson R. Management of women with atypical Papanicolaou tests of undetermined significance by board-certified gynecologists: discrepancies with published guidelines. Am J Obstet Gynecol. 2001;185:551–6. CrossRef
- Schnatz PF, Guile M, O’Sullivan DM, Sorosky JI. Clinical significance of atypical glandular cells on cervical cytology. Obstet Gynecol. 2006;107:701–8.
- Adams AL, Gidley J, Roberson J, Wang W, Eltoum I, Chhieng DC. Clinical significance of unsatisfactory conventional pap smears owing to inadequate squamous cellularity defined by the Bethesda 2001 criterion. Am J Clin Pathol. 2005;123:738–43. CrossRef
- Fidda N, Miron J, Rodgers WH, Rader A. Impact of the new Bethesda System 2001 on specimen adequacy of conventional cervicovaginal smears. Diagn Cytopathol. 2004;30:235–9. CrossRef
- Montz FJ, Monk BJ, Fowler JM, Nguyen L. Natural history of the minimally abnormal Papanicolaou smear. Obstet Gynecol. 1992;80:385–8.
- The ASCUS-LSIL Triage Study (ALTS) Group. A randomized trial on the management of low-grade squamous intraepithelial lesion cytology interpretations. Am J Obstet Gynecol. 2003;188:1393–400.
- Kaplan CP, Bastani R, Marcus A, Breslow L, Nasseri K, Chen L. Low income women with cervical abnormalities: Individual and system factors affecting follow-up. J Women’s Health. 1995;4:179–88. CrossRef
- Benard VB, Lawson HW, Eheman CR, Anderson CR, Helsel W. Adherence to guidelines for follow-up of low-grade cytologic abnormalities among medically underserved women. Obstet Gynecol. 2005;105:1323–8.
- Variations in Practice Guideline Adherence for Abnormal Cervical Cytology in a County Healthcare System
Journal of General Internal Medicine
Volume 23, Issue 5 , pp 575-580
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- quality of care
- practice guidelines
- cervical cancer
- Industry Sectors
- Author Affiliations
- 1. Department of Medicine, Olive View–UCLA Medical Center, Sylmar, CA, USA
- 5. Los Angeles County Department of Public Health, Office of Women’s Health, El Monte, CA, USA
- 2. VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda, CA, USA
- 3. Women’s and Children’s Hospital, University of Southern California, Los Angeles, CA, USA
- 4. Department of Obstetrics and Gynecology, Olive View–UCLA Medical Center, Sylmar, CA, USA