Heywood A, Firman D, Ring I
Epidemiology and Health Information Branch, Queensland Health Promotion Council, Brisbane.
Aust N Z J Public Health. 1996 Jun;20(3):260-6. doi: 10.1111/j.1467-842x.1996.tb01026.x.
This study ascertained the relationships of patient, practitioner and consultation factors with: 1. taking a Pap smear or referral to a specialist in the consultation; and 2. an unsuccessful offer to take a Pap smear or making an appointment for a smear. In a cross-sectional study of 3478 women presenting to 230 randomly selected general practitioners in Brisbane and Toowoomba, information about most recent Pap smear, screening in the consultation, and independent variables were collected from patients and doctors. Relationships between three levels of outcome variable (no action, Pap smear taken or referral, appointment or refusal), and independent variables (practitioner variables, consultation variables, patient variables) were modelled using polytomous logistic regression. Presenting for a routine checkup and breast cancer screening were associated with all types of action. Younger age, longer consultations and consultations with a female practitioner were associated with Pap smear taking and referrals, and not appointments or refusals. Being due for a Pap smear, having blood pressure measured, consulting a younger general practitioner and one who ascribed to current guidelines on screening were associated with an appointment or a refusal, when compared with no action. Results identify different profiles of those who get a Pap smear and those who do not, the former indicating a more proactive patient group, while the latter suggest more active general practitioners who attempted opportunistic screening of passive patients, or women who do not specifically seek Pap smears. We have identified factors that have significance for developing public health programs focused on consumers and providers.
本研究确定了患者、从业者及会诊因素与以下方面的关系：1. 在会诊时进行巴氏涂片检查或转诊至专科医生；2. 未能成功提供巴氏涂片检查或预约涂片检查。在一项对布里斯班和图文巴随机抽取的230名全科医生处就诊的3478名女性进行的横断面研究中，从患者和医生处收集了有关最近一次巴氏涂片检查、会诊中的筛查以及自变量的信息。使用多分类逻辑回归对结果变量的三个水平（无行动、进行巴氏涂片检查或转诊、预约或拒绝）与自变量（从业者变量、会诊变量、患者变量）之间的关系进行建模。进行常规体检和乳腺癌筛查与所有类型的行动相关。年龄较小、会诊时间较长以及与女从业者会诊与进行巴氏涂片检查和转诊相关，而非与预约或拒绝相关。与无行动相比，应进行巴氏涂片检查、测量血压、咨询年轻的全科医生以及遵循当前筛查指南的医生与预约或拒绝相关。结果确定了进行巴氏涂片检查者和未进行者的不同特征，前者表明患者群体更积极主动，而后者表明全科医生更积极主动，他们试图对被动患者或未专门寻求巴氏涂片检查的女性进行机会性筛查。我们已经确定了对制定以消费者和提供者为重点的公共卫生项目具有重要意义的因素。
