Melnikow J, Sierk A, Flocke S, Peters C A
Department of Family Medicine, University of California, Davis, Sacramento.
Arch Fam Med. 1993 Mar;2(3):253-8. doi: 10.1001/archfami.2.3.253.
To determine whether a new system of Papanicolaou test nomenclature (the Bethesda system) or other physician variables influence recommendations for colposcopy and biopsy for women with borderline to moderately abnormal Papanicolaou test results. We hypothesized that physician demographic and practice variables, in addition to Papanicolaou test nomenclature, would influence recommendations for colposcopy.
A survey was mailed to a random sample of 510 active members of the American Academy of Family Physicians.
Three hundred thirty-five (66%) of the eligible physicians responded, representing all 50 states. Of those in active practice, 78% were in private practice, with a mean age of 44 years and a mean time in practice of 10 years. Ninety-three percent of respondents in active practice performed Papanicolaou tests.
Rates of recommendation for colposcopy and biopsy in response to abnormal Papanicolaou test reports framed by a single clinical scenario.
Physicians recommended colposcopy more often when the Bethesda nomenclature system was used to describe the results of the Papanicolaou test. These differences were significant for four specific Papanicolaou smear pairs. Inclusion of recommendations for further evaluation strongly influenced physicians to recommend colposcopy. In multivariable analyses, demographic and practice variables were not associated with recommendations for colposcopy.
The Bethesda system of nomenclature, when compared with a traditional descriptive nomenclature system, influenced family physicians to recommend colposcopy and biopsy more often for abnormal Papanicolaou test results presented in a clinical scenario. Greater utilization of technology and higher medical care costs may result from use of the Bethesda system. Guidelines for evaluation of abnormal Papanicolaou test results are needed for use in conjunction with the Bethesda system guidelines for Papanicolaou test reports.
确定巴氏涂片命名新系统（贝塞斯达系统）或其他医生变量是否会影响对巴氏涂片检查结果为临界至中度异常的女性进行阴道镜检查和活检的建议。我们假设，除巴氏涂片命名外，医生的人口统计学和执业变量也会影响阴道镜检查的建议。
向美国家庭医生学会510名在职会员的随机样本邮寄了一份调查问卷。
335名（66%）符合条件的医生做出了回应，代表了所有50个州。在在职医生中，78%为私人执业，平均年龄44岁，平均执业时间10年。在职医生中93%进行巴氏涂片检查。
针对单一临床病例中异常巴氏涂片检查报告给出的阴道镜检查和活检建议率。
当使用贝塞斯达命名系统描述巴氏涂片检查结果时，医生更常建议进行阴道镜检查。对于四对特定的巴氏涂片，这些差异具有统计学意义。纳入进一步评估的建议强烈影响医生推荐阴道镜检查。在多变量分析中，人口统计学和执业变量与阴道镜检查建议无关。
与传统的描述性命名系统相比，贝塞斯达命名系统促使家庭医生更频繁地对临床病例中呈现的异常巴氏涂片检查结果建议进行阴道镜检查和活检。使用贝塞斯达系统可能会导致技术利用率提高和医疗成本增加。需要制定巴氏涂片检查结果异常评估指南以便与贝塞斯达系统的巴氏涂片检查报告指南一起使用。
