From the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; and the Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
Obstet Gynecol. 2010 Dec;116(6):1332-1340. doi: 10.1097/AOG.0b013e3181fae4ca.
To evaluate the association between physician and practice characteristics and adherence to management guidelines to better understand the factors associated with different screening recommendations by primary care physicians.
We used a cross-sectional nationally representative survey of 950 primary care physicians familiar with human papillomavirus (HPV) testing to assess adherence to management guidelines by analyzing responses to two clinical vignettes of a 35-year-old woman who had Pap and HPV tests results: 1) discordant (normal Pap and positive HPV) or 2) mildly abnormal (atypical squamous cells of undetermined significance Pap and negative HPV). Analyses included multivariable logistic regression.
For the discordant test results, 54.3% (95% confidence interval [CI] 51-57.6%) of physicians recommended both Pap and HPV testing in 6-12 months, adhering to management guidelines. For the mildly abnormal results, only 12.2% (95% CI 10-14.7%) had a guideline-adherent recommendation of Pap testing in 12 months with no HPV test. In multivariable analyses, no significant difference among physicians' specialties was observed for the discordant results. For the mildly abnormal results, physician specialty was associated with guideline adherence in which obstetrician-gynecologists had the highest percent of adherence (19.8%) compared with family and general practitioners (9.3%) and internists (11%) (P<.001).
Even for the most common abnormal results, many physicians reported recommendations that did not adhere to current management guidelines. Evidence-based interventions are needed to improve adherence to management guidelines for the newer HPV DNA test.
评估医生和实践特征与遵循管理指南之间的关联，以更好地了解与初级保健医生不同的筛查建议相关的因素。
我们使用了一项针对 950 名熟悉人乳头瘤病毒 (HPV) 检测的初级保健医生的横断面全国代表性调查，通过分析对两名 35 岁女性的临床病例的回答来评估对管理指南的遵循情况：1）不一致（正常巴氏涂片和 HPV 阳性）或 2）轻度异常（非典型鳞状细胞意义不明的巴氏涂片和 HPV 阴性）。分析包括多变量逻辑回归。
对于不一致的检测结果，54.3%（95%置信区间 [CI] 51-57.6%）的医生建议在 6-12 个月内同时进行巴氏涂片和 HPV 检测，遵循管理指南。对于轻度异常的结果，只有 12.2%（95%CI 10-14.7%）的医生建议在 12 个月内进行巴氏涂片检测，而不进行 HPV 检测，这是符合指南的建议。在多变量分析中，对于不一致的结果，医生的专业之间没有明显的差异。对于轻度异常的结果，医生的专业与遵循指南相关联，其中妇产科医生的遵循率最高（19.8%），而家庭和普通内科医生（9.3%）和内科医生（11%）（P<.001）。
即使是最常见的异常结果，许多医生的建议也不符合当前的管理指南。需要采取循证干预措施来提高对新的 HPV DNA 检测的管理指南的遵循率。
