Singhal Rita, Rubenstein Lisa V, Wang Mingming, Lee Martin L, Raza Anwar, Holschneider Christine H
Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA.
J Gen Intern Med. 2008 May;23(5):575-80. doi: 10.1007/s11606-008-0528-x. Epub 2008 Feb 20.
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.
宫颈癌发病率和死亡率的降低不仅取决于推广宫颈癌筛查，还取决于对异常宫颈细胞学检查进行适当的随访和治疗。
本研究的目的是确定需要对异常宫颈细胞学检查进行随访的女性在遵循指南方面的差异。
研究对象为2000年在一个大型县医疗系统中巴氏试验异常的18岁及以上女性（n = 8571）。
通过在每个细胞学异常程度的可接受时间间隔内是否存在适当的随访程序来确定对指南的遵循情况。没有进行随访研究的患者被视为失访。
在研究对象中，18.5%的人失访。在其余6987名女性中，60.3%接受了最佳治疗，9.4%接受了次优治疗，30.3%接受了较差治疗。细胞学异常程度较高的患者（比值比，1.29；95%置信区间，1.17 - 1.42）、年龄较大的患者（比值比，1.03；95%置信区间，1.02 - 1.030）以及在较大医疗设施接受首次巴氏试验的患者（比值比，1.13；95%置信区间，1.01 - 1.27）的随访率较高。接受最佳治疗与较高的细胞学异常程度（p < .0001）和较大的设施规模（p = .002）呈正相关。护理的地区差异表明，最大的集群失访率最低且护理最优化。
大量宫颈细胞学异常的女性接受的治疗未达最佳。需要进一步研究以确定为提高对异常细胞学随访的指南遵循率而需要针对的具体医疗服务提供方式。
