University of Pennsylvania, Philadelphia, PA 19104, United States.
University of North Carolina, Chapel Hill, NC 27599, United States.
Prev Med. 2018 Nov;116:51-59. doi: 10.1016/j.ypmed.2018.08.027. Epub 2018 Aug 24.
Overuse of clinical preventive services increases healthcare costs and may deprive underserved patients of necessary care. Up to 45% of cervical cancer screening is overuse. We conducted a systematic review of correlates of overuse of cervical cancer screening and interventions to reduce overuse. The search identified 25 studies (20 observational; 5 intervention). Correlates varied by the type of overuse measured (i.e., too frequent, before/after recommended age to start or stop screening, after hysterectomy), the most common correlates of overuse related to patient age (n = 7), OBGYN practice or provider (n = 5), location (n = 4), and marital status (n = 4). Six observational studies reported a decrease in overuse over time. Screening overuse decreased in all intervention studies, which used before-after designs with no control or comparison groups. Observational studies suggest potential targets for de-escalating overuse. Randomized clinical trials are needed to establish best practices for reducing overuse.
过度使用临床预防服务会增加医疗保健成本，并可能使服务不足的患者得不到必要的护理。多达 45%的宫颈癌筛查属于过度使用。我们对宫颈癌筛查过度使用的相关因素和减少过度使用的干预措施进行了系统评价。检索确定了 25 项研究（20 项观察性研究；5 项干预性研究）。与过度使用相关的因素因所测量的过度使用类型而异（即过于频繁、在推荐开始或停止筛查的年龄之前/之后、子宫切除术后），过度使用最常见的相关因素与患者年龄（n=7）、妇产科医生的实践或提供者（n=5）、地理位置（n=4）和婚姻状况（n=4）有关。6 项观察性研究报告称，随着时间的推移，过度使用的情况有所减少。所有使用前后设计且没有对照组或比较组的干预研究均显示筛查过度使用减少。观察性研究表明，有降低过度使用的潜在目标。需要进行随机临床试验来确定减少过度使用的最佳实践。
