IMPROVING ADHERENCE TO SCREENING FOLLOW-UP AMONG WOMEN WITH ABNORMAL PAP SMEARS - RESULTS FROM A LARGE CLINIC-BASED TRIAL OF 3 INTERVENTION STRATEGIES
IMPROVING ADHERENCE TO SCREENING FOLLOW-UP AMONG WOMEN WITH ABNORMAL PAP SMEARS - RESULTS FROM A LARGE CLINIC-BASED TRIAL OF 3 INTERVENTION STRATEGIES
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DOI：
10.1097/00005650-199203000-00004
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发表时间：
1992-03-01
期刊：
影响因子：
3
通讯作者：
BEREK, JS
中科院分区：
文献类型：
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作者：
MARCUS, AC;CRANE, LA;BEREK, JS
在一项涉及 2,000 多名宫颈细胞学异常（子宫颈抹片检查）女性的大型随机试验中，测试了三种基于临床的干预措施，作为提高筛查随访返回率的策略：1）个性化的随访信和小册子； 2) 子宫颈抹片检查幻灯片程序； 3) 交通奖励（公交车通行证/停车证）。使用 2 x 2 x 2 析因设计评估这三种干预措施。这项研究的结果证实，子宫颈抹片检查异常的女性（总体为 29%）筛查随访失败率很高（即没有回访），12 个参与诊所之间存在很大差异（13% 至 42%）。对于样本整体而言，交通激励以及个性化随访和幻灯片计划的联合干预条件对筛查随访都有显着的积极影响。然而，交通激励成为患者亚组中的主要干预条件，这些患者亚组的特点是社会经济地位更不利，患宫颈癌的风险更高，包括接受县卫生部门护理的患者（比值比 (OR) = 1.51；P < .05）；没有健康保险的患者（OR = 1.77；P < .01）；以及子宫颈抹片检查结果更严重的患者（OR = 1.71；P < .05）。相比之下，在具有相对优势且患宫颈癌风险较低的患者亚组中，只有个性化随访和幻灯片计划的组合干预条件与较高的患者复诊率相关。反映这种模式的亚组包括在非县诊所就诊的患者（OR = 4.54；P < .05）和子宫颈抹片检查结果不太严重的患者（OR = 5.16；P < .01）。这些发现的意义在设计基于临床的干预措施以改善筛查随访方面进行了讨论。
In a large randomized trial involving over 2,000 women with abnormal cervical cytology (pap smear), three clinic-based interventions were tested as strategies to increase return rates for screening follow-up: 1) a personalized follow-up letter and pamphlet; 2) a slide-tape program on pap smears; and 3) transportation incentives (bus passes/parking permits). The three interventions were evaluated using a 2 x 2 x 2 factorial design. Results of this study confirm a high rate of loss to screening follow-up (i.e., no return visits) among women with abnormal pap smears (29% overall), with substantial variability among the 12 participating clinics (13% to 42%). For the sample as a whole, both transportation incentives and the combined intervention condition of personalized follow-up and slide-tape program had a significant positive impact on screening follow-up. However, transportation incentives emerged as the dominant intervention condition among patient subgroups that can be characterized as more disadvantaged socioeconomically and at higher risk of developing cervical cancer, including patients receiving care from the county health department (odds ratio (OR) = 1.51; P < .05); patients without health insurance (OR = 1.77; P < .01); and patients with more severe pap smear results (OR = 1.71; P < .05). In contrast, among patient subgroups that can be characterized as relatively more advantaged and at lower risk of developing cervical cancer, only the combined intervention condition of personalized follow-up and slide-tape program was associated with a higher patient return rate. Subgroups reflecting this pattern included patients seen in noncounty clinics (OR = 4.54; P < .05) and patients with less severe pap smear results (OR = 5.16; P < .01). The implications of these findings are discussed in terms of designing clinic-based interventions to improve screening follow-up.