Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA.
Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Prev Med. 2022 Jan;154:106896. doi: 10.1016/j.ypmed.2021.106896. Epub 2021 Nov 17.
Women overdue for cervical cancer screening often have other preventive care gaps. We examined whether mailing unsolicited human papillomavirus (HPV) self-sampling kits to increase cervical cancer screening impacted receipt of other preventive services women were due for: mammography, colorectal cancer (CRC) screening, influenza vaccination, depression screening, and diabetic HbA1c monitoring. From 2014 to 2016, 16,590 underscreened women were randomized to receive a mailed kit or usual care Pap reminders within Kaiser Permanente Washington. We used logistic regression to estimate odds ratios (ORs) of preventive services receipt within 12-months between the intervention vs. control arms, and within the intervention arm (comparing those returning a kit vs. attending Pap vs. nothing), adjusting models for demographic variables. There were no significant between-arm differences in uptake of any of the preventive services: intervention vs. control: mammography OR = 1.01 (95% confidence interval:0.88-1.17), CRC screening OR = 0.98 (0.86-1.13), influenza vaccination OR = 0.99 (0.92-1.06), depression screening OR = 1.07 (0.99-1.16), HbA1c OR = 0.84 (0.62-1.13). Within the intervention arm, preventive services uptake was higher in women who completed cervical cancer screening vs. did not, with stronger effects for women who attended Pap: Pap vs. nothing: mammography OR = 11.81 (8.11-17.19), CRC screening OR = 7.31 (5.57-9.58), influenza vaccination OR = 2.06 (1.82-2.32), depression screening OR = 1.79 (1.57-2.05), HbA1c OR = 3.35 (1.49-7.52); kit vs. nothing: mammography OR = 2.26 (1.56-3.26), CRC screening OR = 5.05 (3.57-7.14), influenza vaccination OR = 1.67 (1.41-1.98), depression screening OR = 1.09 (0.89-1.33), HbA1c OR = 1.23 (0.57-2.65). Mailing HPV self-sampling kits to underscreened women did not negatively impact uptake of other preventive services. However, overall preventive service uptake was the highest among women who attended in-clinic cervical cancer screening.
对于宫颈癌筛查逾期的女性来说，她们往往还存在其他预防保健方面的缺口。我们研究了向这些女性邮寄 HPV 自我采样试剂盒，以增加宫颈癌筛查的效果，同时是否会影响她们接受其他预防服务：乳房 X 光检查、结直肠癌（CRC）筛查、流感疫苗接种、抑郁症筛查和糖尿病患者糖化血红蛋白（HbA1c）监测。2014 年至 2016 年，在 Kaiser Permanente Washington，有 16590 名筛查不足的女性被随机分为接受邮寄试剂盒或常规巴氏涂片提醒的干预组和对照组。我们使用逻辑回归估计干预组与对照组之间 12 个月内接受预防服务的比值比（OR），以及干预组内（比较返回试剂盒、参加巴氏涂片检查和什么都不做的人），为模型调整人口统计学变量。在接受任何预防服务方面，干预组与对照组之间均无显著差异：干预组与对照组相比：乳房 X 光检查 OR=1.01（95%置信区间：0.88-1.17），CRC 筛查 OR=0.98（0.86-1.13），流感疫苗接种 OR=0.99（0.92-1.06），抑郁症筛查 OR=1.07（0.99-1.16），HbA1c OR=0.84（0.62-1.13）。在干预组内，与未接受宫颈癌筛查的女性相比，完成宫颈癌筛查的女性接受预防服务的比例更高，而参加巴氏涂片检查的女性效果更强：巴氏涂片检查与什么都不做相比：乳房 X 光检查 OR=11.81（8.11-17.19），CRC 筛查 OR=7.31（5.57-9.58），流感疫苗接种 OR=2.06（1.82-2.32），抑郁症筛查 OR=1.79（1.57-2.05），HbA1c OR=3.35（1.49-7.52）；试剂盒与什么都不做相比：乳房 X 光检查 OR=2.26（1.56-3.26），CRC 筛查 OR=5.05（3.57-7.14），流感疫苗接种 OR=1.67（1.41-1.98），抑郁症筛查 OR=1.09（0.89-1.33），HbA1c OR=1.23（0.57-2.65）。向筛查不足的女性邮寄 HPV 自我采样试剂盒不会对其他预防服务的使用产生负面影响。然而，在参加门诊宫颈癌筛查的女性中，整体预防服务的使用比例最高。
