荷兰家庭医疗中宫颈癌筛查的参与情况。

Attendance to cervical cancer screening in family practices in The Netherlands.

作者信息

Hermens R P, Tacken M A, Hulscher M E, Braspenning J C, Grol R P

机构信息

Center for Quality of Care Research (WOK), Universities of Nijmegen and Maastrict, Nijmegen, The Netherlands.

出版信息

Prev Med. 2000 Jan;30(1):35-42. doi: 10.1006/pmed.1999.0603.

DOI:10.1006/pmed.1999.0603

PMID:10642458

Abstract

BACKGROUND

The effectiveness of three different organizational approaches to cervical cancer screening (community based, family practice based, and a combination) was evaluated in nationally representative family practices.

METHOD

We selected 122 family practices with a computerized sex-age register from a database of 1, 251 family practices, representative of all 4,758 family practices in The Netherlands. Approximately 40 practices were linked with each approach. We measured the attendance, the reasons for nonattendance, and the influence of a reminder on the attendance of women invited for cervical screening in September, October, and November 1996. The patients were grouped according to age. A cross-sectional design was used for the study.

RESULTS

For younger women, the total attendance rate, coverage (percentage of women "protected" against cervical cancer), and control rate (percentage of women with medical reasons for nonattendance or postponement of the smear) were highest in practices using the family practice-based approach (68, 77, and 90%, respectively) and lowest in practices with the community-based approach (53, 62, and 68%, respectively). For older women, the family practice-based approach and the combination approach were associated with attendance rates significantly higher than those for the community-based approach (approximately 60, 80, and 80% vs 47, 67, and 70%, respectively). A reminder sent by the family physician to women not responding to an initial invitation increased the attendance rate by 7 to 11% in both age categories, depending on who had sent the first invitation.

CONCLUSION

A family practice-based cervical screening approach appeared to be the most effective at a national level, achieving the highest attendance rate, coverage, and control rate.

摘要

背景

在具有全国代表性的家庭医疗诊所中，评估了三种不同的宫颈癌筛查组织方式（基于社区、基于家庭医疗以及二者结合）的有效性。

方法

我们从1251家家庭医疗诊所的数据库中选取了122家拥有计算机化性别年龄登记册的诊所，这些诊所能代表荷兰所有4758家家庭医疗诊所。每种方式大约与40家诊所相关联。我们测量了1996年9月、10月和11月被邀请进行宫颈癌筛查的女性的就诊率、未就诊原因以及提醒对就诊率的影响。患者按年龄分组。本研究采用横断面设计。

结果

对于年轻女性，采用基于家庭医疗方式的诊所的总就诊率、覆盖率（“预防”宫颈癌的女性百分比）和控制率（因医疗原因未进行涂片检查或推迟涂片检查的女性百分比）最高（分别为68%、77%和90%），而采用基于社区方式的诊所最低（分别为53%、62%和68%）。对于老年女性，基于家庭医疗的方式和结合方式的就诊率显著高于基于社区的方式（分别约为60%、80%、80%对47%、67%、70%）。家庭医生向未对初次邀请做出回应的女性发送提醒后，两个年龄组的就诊率均提高了7%至11%，这取决于谁发送了第一次邀请。