得克萨斯州里奥格兰德河谷地区改善癌前宫颈病变治疗的综合方案。
A Comprehensive Program to Improve Treatment of Precancerous Cervical Lesions in the Rio Grande Valley of Texas.
机构信息
The University of Texas MD Anderson Cancer Center, Houston, Texas (Drs Varon, Salcedo, Baker, and Schmeler, and Mr Fellman); The University of Texas Health Science Center, School of Public Health, Houston, Texas (Drs Troisi, Fernandez, and Ruosha); The University of Texas Health Science Center, School of Public Health Brownsville Regional Campus, Brownsville, Texas (Ms Gasca, Drs Gowen, Fisher-Hoch, and Reininger); Harris Health, Houston, Texas (Ms Daheri); The University of Texas Medical Branch, Houston, Texas (Dr Rodriguez); McGovern Medical School, Houston, Texas (Mr Toscano) Su Clinica, Harlingen, Texas (Mss Guerra and Cavazos, and Dr Marin).
出版信息
J Public Health Manag Pract. 2024;30(1):89-98. doi: 10.1097/PHH.0000000000001771. Epub 2023 Jun 20.
OBJECTIVE
To assess the impact of a multicomponent intervention in women with cervical dysplasia who were treated with loop electrosurgical excision procedure (LEEP), as well as the time between colposcopy and treatment.
DESIGN
Retrospective cohort study.
INTERVENTION
Clinic participation in a multicomponent cervical cancer prevention program that included community outreach, patient in-reach, and navigation, as well as provider capacity building with in-person training and ongoing telementoring through Project ECHO.
MAIN OUTCOME MEASURES
Medical records were reviewed to evaluate women with cervical dysplasia undergoing treatment with LEEP within 90 days of colposcopy, as well as time between colposcopy and treatment. Baseline data from year 1 were compared with each subsequent year of implementation. Additional variables examined included patient's age, history of abnormal screening results, and percentage of families living below poverty line based on county of residence, parity, and clinic site. We performed logistic regression and multiple linear regression analyses to assess the programmatic impact in the outcomes of interest by year of program implementation.
RESULTS
A total of 290 women were included in the study. The proportion of women undergoing treatment within 90 days of colposcopy increased from 76.2% at baseline to 91.3% in year 3 and 92.9% in year 4 of program implementation. The odds of undergoing treatment within 90 days were 5.11 times higher in year 4 of program implementation than at baseline. The mean time between colposcopy and LEEP decreased from 62 days at baseline to 45 days by year 4 of program implementation.
CONCLUSIONS
Implementation of our multicomponent cervical cancer prevention program increased the proportion of women undergoing LEEP within 90 days of colposcopy and decreased the time between colposcopy and LEEP. This program has the potential to support cervical cancer prevention efforts and could be implemented in other low-resource settings.
目的
评估多组分干预措施对接受环形电切术（LEEP）治疗的宫颈上皮内瘤变患者的影响，以及阴道镜检查和治疗之间的时间间隔。
设计
回顾性队列研究。
干预措施
参与多组分宫颈癌预防计划，包括社区外展、患者内部服务以及导航，以及通过 ECHO 项目进行现场培训和持续远程指导的提供者能力建设。
主要观察指标
评估在阴道镜检查后 90 天内接受 LEEP 治疗的宫颈上皮内瘤变患者的病历，并评估阴道镜检查和治疗之间的时间间隔。比较第 1 年的基线数据与随后每年的实施情况。检查的其他变量包括患者的年龄、异常筛查结果的病史以及根据居住地、产次和诊所地点确定的贫困线以下家庭的百分比。我们进行逻辑回归和多元线性回归分析，以评估方案实施年份对感兴趣结局的方案影响。
结果
共纳入 290 名患者。在阴道镜检查后 90 天内接受治疗的患者比例从基线时的 76.2%增加到第 3 年的 91.3%和第 4 年的 92.9%。在第 4 年实施方案时，在 90 天内接受治疗的可能性是基线时的 5.11 倍。阴道镜检查和 LEEP 之间的平均时间从基线时的 62 天缩短到第 4 年的 45 天。
结论
实施我们的多组分宫颈癌预防计划增加了在阴道镜检查后 90 天内接受 LEEP 治疗的患者比例，并缩短了阴道镜检查和 LEEP 之间的时间间隔。该计划有可能支持宫颈癌预防工作，并可在其他资源匮乏的环境中实施。
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