Hueston W J, Stiles M A
Menifee Medical Center, Frenchburg, Ky.
Arch Intern Med. 1994 Jul 11;154(13):1473-7.
There has been evidence that, in primary care practices, health screening tests are not ordered in random fashion but instead are coupled or bundled into distinct groups. This study was performed to determine if the Papanicolaou (Pap) smear serves as a marker for other health screening tests.
The study consisted of a retrospective chart review of female patients over the age of 18 years at three rural health clinics, followed by a prospective study of patients during a 3-month period in five rural family practice clinics. The study focused on whether a Pap smear was performed and whether a breast examination, mammogram, rectal examination or stool occult blood test, or serum cholesterol testing was performed.
In both the retrospective and prospective series, patients who received Pap smears were significantly more likely to receive breast examinations, mammograms, colorectal screening and cholesterol tests. In addition, the coupling of other screening tests with the Pap smear appeared to increase with advancing patient age, with a decline after age 70 years. In patients who did not have Pap smears, only cholesterol testing increased as patients aged.
Health screening tests in women are associated with the performance of a Pap smear. Providers may use the Pap smear as a marker of whether a woman has received screening for several other medical problems. Thus, the Pap smear can be considered a "sentinel" test for health screening in women, and efforts to identify women at high risk and increase health promotion and disease prevention in this group should focus on women who have not received this test.
有证据表明，在基层医疗实践中，健康筛查测试并非随机进行，而是被组合或捆绑成不同的组。本研究旨在确定巴氏涂片检查是否可作为其他健康筛查测试的一个指标。
该研究包括对三家农村健康诊所中18岁以上女性患者的病历进行回顾性审查，随后对五家农村家庭诊所的患者进行为期3个月的前瞻性研究。研究重点在于是否进行了巴氏涂片检查以及是否进行了乳房检查、乳房X光检查、直肠检查或粪便潜血试验，或血清胆固醇检测。
在回顾性和前瞻性系列研究中，接受巴氏涂片检查的患者明显更有可能接受乳房检查、乳房X光检查、结肠直肠癌筛查和胆固醇检测。此外，其他筛查测试与巴氏涂片检查的组合似乎随着患者年龄的增长而增加，在70岁以后有所下降。在未进行巴氏涂片检查的患者中，只有胆固醇检测随着患者年龄的增长而增加。
女性的健康筛查测试与巴氏涂片检查的实施有关。医疗服务提供者可将巴氏涂片检查作为女性是否接受了其他几种医疗问题筛查的一个指标。因此，巴氏涂片检查可被视为女性健康筛查的一项“哨兵”测试，识别高危女性并加强该群体健康促进和疾病预防的努力应聚焦于未接受此项检查的女性。
