Cervical cancer screening in the urgent care setting
Cervical cancer screening in the urgent care setting
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DOI：
10.1046/j.1525-1497.2000.08001.x
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发表时间：
2000-06-01
影响因子：
5.7
通讯作者：
Mehler, PS
中科院分区：
文献类型：
--
作者：
Batal, H;Biggerstaff, S;Mehler, PS
目的：探讨在急诊门诊开展宫颈癌筛查的可行性。设计：前瞻性随机试验。单位：公立教学医院。患者：到紧急护理诊所就诊的妇女，其评估需要盆腔检查，符合参加的条件。在过去的一年中，在我们的机构做过子宫切除术、记录在案的巴氏涂片检查、不会说英语或西班牙语、或有明显阴道出血的妇女被排除在外。到妇科诊所接受例行子宫颈抹片检查的妇女被用作随访率、子宫颈抹片检查充分性和子宫颈抹片检查异常的对照组。干预：随机分配到干预组的妇女在盆腔检查中进行了巴氏涂片检查，而常规护理组的妇女则被鼓励在晚些时候预约妇科诊所。两组妇女完成了关于宫颈癌危险因素和人口统计信息的相同问卷。测量和主要结果：干预组111名妇女中94名（84.7%）接受了巴氏试验，而常规护理组86名妇女中有25名（29%）接受了巴氏试验（P < 0.01）。然而，干预组21名子宫颈抹片检查异常的妇女中只有5名（24%）接受了随访，而同期在妇科诊所进行自我推荐的常规年度检查的10名妇女中有6名（60%）接受了随访（P = .11）。在急诊诊所获得的子宫颈抹片检查在异常率（22.3%对20%，P = 0.75）和标本充分性（67%对72%，P = 0.54）方面与妇科诊所相似。结论：急诊门诊就诊可作为不太可能遵守宫颈癌筛查建议的妇女进行巴氏试验筛查的机会。然而，为了从这种干预中获得充分的潜在益处，必须开发一种改进的过程来确保患者随访。
OBJECTIVE: To determine the feasibility of cervical cancer screening in an urgent care clinic.DESIGN: Prospective randomized trial.SETTING: Public teaching hospital.PATIENTS: Women presenting to the urgent care clinic whose evaluation necessitated a pelvic examination were eligible for participation. Women who had a hysterectomy, had a documented Pap test at our institution in the past year, did not speak English or Spanish, or had significant vaginal bleeding were excluded. Women presenting to the gynecology clinic for a scheduled Pap test were used as a comparison group for rates of follow-up, Pap smear adequacy, and Pap smear abnormalities.INTERVENTIONS: Women randomized to the intervention group had a Pap test performed as part of their pelvic examination, while women in the usual care group were encouraged to schedule an appointment in the gynecology clinic at a later date. The women in the two groups completed identical questionnaires regarding cervical cancer risk factors and demographic information.MEASUREMENTS AND MAIN RESULTS: Ninety-four (84.7%) of 111 women in the intervention group received a Pap test, as compared with 25 (29%) of 86 in the usual care group (P < .01). However, only 5 (24%) of 21 women with abnormal Pap smears in the intervention group received follow-up compared with 6 (60%) of 10 women seen during the same time period in the gynecology clinic for self-referred, routine annual examinations (P = .11). Pap smears obtained in the urgent care clinic were similar to those in the gynecology clinic with regard to abnormality rate (22.3% vs 20%; P = .75, respectively) and specimen adequacy (67% vs 72%; P = .54, respectively).CONCLUSIONS: Urgent care clinic visits can be used as opportunities to perform Pap test screening in women who are unlikely to adhere to cervical cancer screening recommendations. However, to accrue the full potential benefit from this intervention, an improved process to ensure patient follow-up must be developed.