Keehbauch Jennifer, Green Lizina, Lugo Nadia, Pepe Julie
Florida Hospital Family Medicine Residency, Winter Park, FL, USA.
Fam Med. 2012 Oct;44(9):650-3.
The study objective was to determine the influence of the 2001 and 2006 American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines changes on colposcopy training at one family medicine residency.
We conducted a retrospective chart review from January 1, 2000 to October 31, 2009. The 2001 ASCCP guidelines were fully implemented into our practice in June 2002 and the 2006 guidelines in June 2008. Data were extracted from our electronic medical records and delineated into three groups: 2000-2002 (pre-2001 guideline changes), 2003-2007 (post-2001 and pre-2006 update), and 2008-2009 (post 2006 changes) for total female patient visits aged 18-75 years, pap smears, and colposcopies. An ANOVA post-hoc comparison test was performed on the three data groups to test significance.
After the 2001 guidelines, there was a 28.6% significant decrease in colposcopies (CI=0.20-0.37). An additional, 16.5% significant decrease occurred after the 2006 revisions (CI=0.06-0.28). Consequently, residents performed 45.1% fewer colposcopies. The total number of pap smears remained relatively unchanged.
Implementation of the 2001 and 2006 ASCCP guidelines significantly reduced the number colposcopies performed, resulting in greater difficulty training competent family medicine residents in colposcopy.
本研究的目的是确定2001年和2006年美国阴道镜及子宫颈病理学会（ASCCP）指南的变化对一家家庭医学住院医师培训项目中阴道镜检查培训的影响。
我们进行了一项回顾性病历审查，时间跨度为2000年1月1日至2009年10月31日。2001年ASCCP指南于2002年6月在我们的实践中全面实施，2006年指南于2008年6月实施。数据从我们的电子病历中提取，并分为三组：2000 - 2002年（2001年指南变更前）、2003 - 2007年（2001年之后和2006年更新之前）以及2008 - 2009年（2006年变更后），涵盖年龄在18 - 75岁的女性患者就诊总数、巴氏涂片检查和阴道镜检查。对这三组数据进行方差分析事后比较检验以检验显著性。
2001年指南实施后，阴道镜检查显著减少了28.6%（置信区间=0.20 - 0.37）。2006年修订后又显著减少了16.5%（置信区间=0.06 - 0.28）。因此，住院医师进行的阴道镜检查减少了45.1%。巴氏涂片检查的总数保持相对不变。
2001年和2006年ASCCP指南的实施显著减少了阴道镜检查的数量，导致培训合格的家庭医学住院医师进行阴道镜检查的难度加大。
