Rosenlund Ingvild Mathiesen, Leivseth Linda, Nilsen Ingard, Førde Olav Helge, Revhaug Arthur
Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromsø, Norway.
BMC Womens Health. 2017 Nov 21;17(1):114. doi: 10.1186/s12905-017-0471-2.
Based on moderate quality evidence, routine pelvic examination is strongly recommended against in asymptomatic women. The aims of this study was to quantify the extent of routine pelvic examinations within specialized health care in Norway, to assess if the use of these services differs across hospital referral regions and to assess if the use of colposcopy and ultrasound differs with gynecologists' payment models.
Nationwide cross-sectional study including all women aged 18 years and older in Norway in the years 2014-16 (2,038,747). Data was extracted from the Norwegian Patient Registry and Statistics Norway. The main outcome measures were 1. The number of appointments per 1000 women with a primary diagnosis of "Encounter for gynecological examination without complaint, suspected or reported diagnosis." 2. The age-standardized number of these appointments per 1000 women in the 21 different hospital referral regions of Norway. 3. The use of colposcopy and ultrasound in routine pelvic examinations, provided by gynecologists with fixed salaries and gynecologists paid by a fee-for-service model.
Annually 22.2 out of every 1000 women in Norway had a routine pelvic examination, with variation across regions from 6.6 to 43.9 per 1000. Gynecologists with fixed salaries performed colposcopy in 1.6% and ultrasound in 74.5% of appointments. Corresponding numbers for fee-for-service gynecologists were 49.2% and 96.2%, respectively.
Routine pelvic examinations are widely performed in Norway. The variation across regions is extensive. Our results strongly indicate that fee-for-service payments for gynecologists skyrocket the use of colposcopy and increase the use of ultrasound in pelvic examinations of asymptomatic women.
基于中等质量的证据，强烈不建议对无症状女性进行常规盆腔检查。本研究的目的是量化挪威专科医疗保健中常规盆腔检查的范围，评估这些服务的使用在不同医院转诊区域是否存在差异，以及评估阴道镜检查和超声检查的使用是否因妇科医生的支付模式而异。
全国性横断面研究，纳入2014 - 2016年挪威所有18岁及以上的女性（共2,038,747人）。数据从挪威患者登记处和挪威统计局提取。主要结局指标为：1. 每1000名女性中以“无主诉、疑似或报告诊断的妇科检查就诊”为主要诊断的预约次数。2. 挪威21个不同医院转诊区域中每1000名女性的这些预约次数的年龄标准化数值。3. 由固定薪资的妇科医生和按服务收费模式支付薪酬的妇科医生在常规盆腔检查中进行阴道镜检查和超声检查的情况。
挪威每年每1000名女性中有22.2人进行常规盆腔检查，各地区差异较大，每1000人中从6.6人到43.9人不等。固定薪资的妇科医生在1.6%的预约中进行阴道镜检查，在74.5%的预约中进行超声检查。按服务收费的妇科医生相应的数字分别为49.2%和96.2%。
常规盆腔检查在挪威广泛开展。各地区差异很大。我们的结果强烈表明，对妇科医生按服务收费会大幅增加无症状女性盆腔检查中阴道镜检查的使用，并增加超声检查的使用。
