Reid S E, Simpson J M, Britt H C
Department of General Practice, University of Sydney, Westmead Hospital, NSW.
Aust N Z J Public Health. 1997 Jun;21(3):257-64. doi: 10.1111/j.1467-842x.1997.tb01696.x.
We investigated the characteristics of Australian general practice that predict performance of Pap smears by secondary analysis of the Australian Morbidity and Treatment Survey 1990 to 1991. Chi-squared analysis identified potential associations between Pap smear rate and patient, doctor and practice variables. Significant associations were examined using logistic regression and generalised estimating equations. Participants were 495 general practitioners who collected information on 113,468 doctor-patient encounters, of which 43,211 encounters involved females aged 18 to 70 years. Pap smear encounter (2449) were identified and classified as patient-requested (62 per cent), diagnostic (5 per cent) or opportunistic (33 per cent). The large difference in the unadjusted Pap smear rates per 100 female encounters for female general practitioners (11.7) and male general practitioners (4.2) required separate analysis by sex of the general practitioner. For male general practitioners, a Pap smear was less likely: as patient age increased; for new patients; for general practitioners with less general practice experience; for general practitioners with no postgraduate qualifications; with metropolitan practice location; and if the practice had more than 25 per cent of patients with English as a second language. For female general practitioners, a Pap smear was less likely: for older known patients; as the age of the general practitioners increased; and for management of fewer problems per 100 encounters. A Pap smear was less likely to be opportunistic: as patient age increased; for general practitioners who were Australian graduates; and for general practitioners with no postgraduate qualifications. Consideration of patient, doctor, and general practice characteristics may facilitate the design of interventions to improve cervical cancer screening.
我们通过对1990年至1991年澳大利亚发病率与治疗调查进行二次分析，研究了澳大利亚全科医疗中预测巴氏涂片检查执行情况的特征。卡方分析确定了巴氏涂片率与患者、医生及医疗实践变量之间的潜在关联。使用逻辑回归和广义估计方程对显著关联进行了检验。参与者为495名全科医生，他们收集了113468次医患诊疗信息，其中43211次诊疗涉及18至70岁的女性。识别出巴氏涂片诊疗（2449次）并将其分类为患者要求（62%）、诊断性（5%）或机会性（33%）。女性全科医生每100次女性诊疗的未调整巴氏涂片率（11.7）与男性全科医生（4.2）差异巨大，因此需要按全科医生性别分别进行分析。对于男性全科医生，进行巴氏涂片检查的可能性较小的情况有：随着患者年龄增加；对于新患者；对于全科医疗经验较少的全科医生；对于没有研究生学历的全科医生；在大都市地区执业；以及如果该医疗实践中有超过25%的患者以英语作为第二语言。对于女性全科医生，进行巴氏涂片检查的可能性较小的情况有：对于年龄较大的已知患者；随着全科医生年龄增加；以及每100次诊疗中处理的问题较少。进行巴氏涂片检查属于机会性的可能性较小的情况有：随着患者年龄增加；对于澳大利亚毕业的全科医生；以及对于没有研究生学历的全科医生。考虑患者、医生和全科医疗特征可能有助于设计改善宫颈癌筛查的干预措施。
