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Association Between Physician Specialty and Uptake of New Medical Technologies: HPV Tests in Florida Medicaid

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Abstract

BACKGROUND

It is well established that specialists often adopt new medical technologies earlier than generalists, and that racial and ethnic minority patients are less likely than White patients to receive many procedures and prescription drugs. However, little is known about the role that specialists or generalists may play in reducing racial and ethnic disparities in uptake of new medical technologies. Human papillomavirus (HPV) DNA tests, introduced as a cervical cancer screening tool in 2000, present a rich context for exploring patterns of use across patient and provider subgroups.

OBJECTIVE

To identify patient characteristics and the provider specialty associated with overall and appropriate use of HPV DNA tests over time, and to examine the associations between clinical guidelines and adoption of the test in an underserved population.

DESIGN

Retrospective longitudinal study using Florida Medicaid administrative claims data.

PARTICIPANTS

Cervical cancer screening test claims for 415,239 female beneficiaries ages 21 to 64 from July 2001 through June 2006.

MAIN MEASURES

Overall and appropriate use of HPV DNA tests.

KEY RESULTS

Although minority women were initially less likely than White women to receive HPV DNA tests, test use grew more rapidly among Black and Hispanic women compared to White women. Obstetricians/gynecologists were significantly more likely than primary care providers to administer HPV DNA tests. Release of the first set of clinical guidelines was associated with a large increase in the use of HPV DNA tests (adjusted odds ratio: 2.46, p < 0.0001); subsequent guidelines were associated with more modest increases.

CONCLUSIONS

Uptake of new cervical cancer screening protocols can occur quickly among traditionally underserved groups and may be aided by early adoption by specialists.

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Acknowledgements

The author gratefully acknowledges Paul Cleary, Richard Frank, and Sue Goldie for their thoughtful comments on earlier drafts of the manuscript, and Christina Fu for outstanding technical assistance. The author was supported, in part, by a George Bennett Fellowship from the Foundation for Informed Medical Decision Making.

This project has been funded in whole or in part with federal funds from the National Cancer Institute, National Institutes of Health, under contract no. HHSN261200800001E. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

Conflicts of Interest

The author declares no conflicts of interest.

Author information

Authors and Affiliations

  1. Clinical Research Directorate/Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, MD 21702, Contractor to: Applied Cancer Screening Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, 20852, USA

    Rebecca Anhang Price PhD

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  1. Rebecca Anhang Price PhD
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Corresponding author

Correspondence to Rebecca Anhang Price PhD.

Appendices

Clinical Practice Guidelines for the Use of HPV DNA Testing, 2002–2004

 

Consensus Guidelines from the American Society for Colposcopy and Cervical Pathology (April 2002)22

American Cancer Society Guidelines (November 2002)24

United States Preventive Services Task Force Guidelines (January 2003)21

American College of Obstetricians and Gynecologists Guidelines (August 2003)23

Co-sponsored Interim Guidance from National Cancer Institute, American Society of Colposcopy and Cervical Pathology and American Cancer Society (February 2004)20

HPV DNA testing for triage of ASC-US Pap test results

Yes

Not addressed

Not addressed

Yes

Yes

HPV DNA testing in conjunction with Pap test for primary screening in women age 30+

Not addressed

It would be reasonable to consider that for women aged 30 or over screening may be performed every 3 years using cytology combined with a test for high-risk HPV types

Insufficient evidence to recommend for or against routine screening for HPV infection

Once a woman reaches age 30, it is appropriate for her to have the test for the HPV at the same time as the Pap

HPV DNA testing may be added to cervical cytology for screening in women aged 30 years and older

Procedure Codes

Claim

Procedure codes

HPV DNA testing

87620, 87621, 87622

Thin preparation Pap testing

88142, 88143, 88174, 88175

Conventional Pap testing

88141,88144, 88145, 88147, 88148, 88150-5, 88160-2, 88164-7

Colposcopy

57452, 57454

Clinical visit

99201-5, 99211-5, 99241-5, 99385-6, 99395-6

Hysterectomy

58150, 58152, 58200, 58210, 58240, 58260, 58262-3, 58267, 58270, 58275, 58280, 58285

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Anhang Price, R. Association Between Physician Specialty and Uptake of New Medical Technologies: HPV Tests in Florida Medicaid. J GEN INTERN MED 25, 1178–1185 (2010). https://doi.org/10.1007/s11606-010-1415-9

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  • DOI: https://doi.org/10.1007/s11606-010-1415-9

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