Formerly VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia.
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia.
PLoS One. 2020 Jan 29;15(1):e0228042. doi: 10.1371/journal.pone.0228042. eCollection 2020.
The National Cervical Screening Program (NCSP) in Australia underwent major changes on December 1st, 2017. The program changed from 2-yearly Pap testing for women aged 18-69 years to 5-yearly HPV testing for women aged 25-74 years including differential management pathways for oncogenic HPV 16/18 positive versus HPV non16/18 positive test results and the option of self-collection for under-screened women. We conducted a survey among cervical screening providers in primary care to assess their level of preparedness in undertaking cervical screening before (pre-renewal) and after (post-renewal) the new program was implemented. Surveys were conducted between 14th August and 30th November 2017 (pre-renewal) and 9th February and 26th October 2018 (post-renewal) among cervical screening providers who attended education sessions related to the new guidelines. Preparedness was assessed in three areas: 1) level of comfort implementing the new guidelines (7 questions), 2) level of confidence in their ability to convey information about the new guidelines (9 questions) and 3) level of agreement regarding access to resources to support implementation (11 questions). Proportions were calculated for each question response and pre- and post-renewal periods compared using generalised linear models. Open-ended questions related to anticipated barriers and ways to overcome barriers were also included in the questionnaires. Compared to the pre-renewal period, a higher proportion of practitioners in the post-renewal period were more comfortable offering routine screening to women ≥25 years (p = 0.005) and more confident explaining the rationale for not screening before 25 years (p = 0.015); confident explaining a positive HPV 16/18 (p = 0.04) and HPV non 16/18(p = 0.013) test result and were comfortable with not referring women with a positive HPV non 16/18 test result and low grade/negative cytology for colposcopy (p = 0.01). A higher proportion of Victorian practitioners in the post-renewal period sample were also comfortable (p = 0.04) and confident (p = 0.015) recommending self-collection to under-screened women and agreed that self-collection is a reliable test (p = 0.003). The most commonly reported suggestion was to provide information, education and communication materials to both patients and practitioners. Compared to the pre-renewal period, practitioners in the post-renewal period were better prepared to implement the renewed screening program. Healthcare providers require further support to implement the self-collection pathway.
澳大利亚国家宫颈筛查计划（NCSP）于 2017 年 12 月 1 日进行了重大改革。该计划将女性 18-69 岁时每 2 年进行一次巴氏涂片检查改为每 5 年进行一次 HPV 检查，包括对致癌 HPV 16/18 阳性和 HPV 非 16/18 阳性检测结果的差异化管理途径，以及为未充分筛查的女性提供自我采集的选择。我们在初级保健中的宫颈筛查提供者中进行了一项调查，以评估他们在新计划实施之前（更新前）和之后（更新后）进行宫颈筛查的准备情况。调查于 2017 年 8 月 14 日至 11 月 30 日（更新前）和 2018 年 2 月 9 日至 10 月 26 日（更新后）期间在参加与新指南相关的教育课程的宫颈筛查提供者中进行。准备情况在三个方面进行评估：1）实施新指南的舒适度（7 个问题），2）传达新指南信息的能力信心（9 个问题）和 3）对支持实施的资源的认同程度（11 个问题）。每个问题的回答比例均进行了计算，并使用广义线性模型比较了更新前和更新后的时期。调查问卷还包括有关预期障碍和克服障碍方法的开放式问题。与更新前相比，更新后有更高比例的从业者更愿意为≥25 岁的女性提供常规筛查（p = 0.005），并更有信心解释不在 25 岁之前筛查的理由（p = 0.015）；有信心解释 HPV 16/18 阳性（p = 0.04）和 HPV 非 16/18 阳性（p = 0.013）检测结果，并对不将 HPV 非 16/18 阳性检测结果和低级别/阴性细胞学结果的女性转诊进行阴道镜检查感到满意（p = 0.01）。更新后时期的维多利亚州从业者中也有更高比例的人感到舒适（p = 0.04）和自信（p = 0.015），并建议对未充分筛查的女性进行自我采集，并且同意自我采集是一种可靠的检测方法（p = 0.003）。最常报告的建议是向患者和从业人员提供信息、教育和沟通材料。与更新前相比，更新后时期的从业者为实施新的筛查计划做好了更好的准备。医疗保健提供者需要进一步的支持来实施自我采集途径。
