Specialty Differences in Primary Care Physician Reports of Papanicolaou Test Screening Practices: A National Survey, 2006 to 2007
Specialty Differences in Primary Care Physician Reports of Papanicolaou Test Screening Practices: A National Survey, 2006 to 2007
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DOI：
10.7326/0003-4819-151-9-200911030-00005
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发表时间：
2009-11-03
影响因子：
39.2
通讯作者：
Coughlin, Steven S.
中科院分区：
文献类型：
--
作者：
Yabroff, K. Robin;Saraiya, Mona;Coughlin, Steven S.
背景：宫颈癌筛查指南在2002年和2003年进行了实质性修订。关于初级保健医生当前巴氏试验筛查实践的信息很少，包括开始、频率和停止。目的：评估美国当前巴氏试验筛查实践。设计：横断面调查。设置：2006年至2007年期间全国代表性的医生样本。参与者：1212名初级保健医生。测量：该调查包括关于医生和实践特征的问题以及巴氏筛查的建议，这些问题以临床小插曲的形式呈现，按年龄、性别和筛查史描述女性。一个复合测量指南一致的applications-was创建通过使用反应的小插曲，其中主要的指导方针是uniform.Results：大多数医生报告提供巴氏试验，他们符合条件的患者（91.0% [95%CI，89.0%至92.6%]）。在巴氏试验提供者（n = 1114）中，筛查实践，包括订购或执行的试验数量，患者提醒系统的使用，以及使用的细胞学方法，因医生专业而异（P < 0.001）。虽然大多数巴氏试验提供者报告说，筛查指南在他们的临床实践中非常有影响力，但很少有指南一致的建议，即在多个小片段中开始和停止巴氏筛查（22.3% [CI，19.9%至25.0%]）。指南一致的建议因专业而异（产科/妇科，16.4%;内科，27.5%;家庭或全科，21.1%）。与妇产科医生相比，内科专家和家庭或全科医生更可能有与指南一致的筛查建议（优势比分别为1.98 [CI，1.22至3.23]和1.45 [CI，0.99至2.13]）。局限性：医生自我报告可能反映了理想化而非实际实践。结论：初级保健医生对巴氏试验筛查的建议与筛查指南不一致，反映了过度使用筛查。需要实施有效的干预措施，重点是潜在的可修改的医生和实践因素，以改善筛查实践。主要资金来源：国家癌症研究所，疾病控制和预防中心，以及医疗保健研究和质量机构。
Background: Cervical cancer screening guidelines were substantially revised in 2002 and 2003. Little information is available about primary care physicians' current Papanicolaou (Pap) test screening practices, including initiation, frequency, and stopping.Objective: To assess current Pap test screening practices in the United States.Design: Cross-sectional survey.Setting: Nationally representative sample of physicians during 2006 to 2007.Participants: 1212 primary care physicians.Measurements: The survey included questions about physician and practice characteristics and recommendations for Pap screening presented as clinical vignettes describing women by age and by sexual and screening histories. A composite measure-guideline-consistent recommendations-was created by using responses to vignettes in which major guidelines were uniform.Results: Most physicians reported providing Pap tests to their eligible patients (91.0% [95% CI, 89.0% to 92.6%]). Among Pap test providers (n = 1114), screening practices, including number of tests ordered or performed, use of patient reminder systems, and cytology method used, varied by physician specialty (P < 0.001). Although most Pap test providers reported that screening guidelines were very influential in their clinical practice, few had guideline-consistent recommendations for starting and stopping Pap screening across multiple vignettes (22.3% [CI, 19.9% to 25.0%]). Guideline-consistent recommendations varied by specialty (obstetrics/gynecology, 16.4%; internal medicine, 27.5%; and family or general practice, 21.1%). Compared with obstetricians/gynecologists, internal medicine specialists and family or general practice specialists were more likely to have guideline-consistent screening recommendations (odds ratio, 1.98 [CI, 1.22 to 3.23] and 1.45 [CI, 0.99 to 2.13], respectively) in multivariate analysis.Limitation: Physician self-report may reflect idealized rather than actual practice.Conclusion: Primary care physicians' recommendations for Pap test screening are not consistent with screening guidelines, reflecting overuse of screening. Implementation of effective interventions that focus on potentially modifiable physician and practice factors is needed to improve screening practice. Primary Funding Source: National Cancer Institute, Centers for Disease Control and Prevention, and Agency for Healthcare Research and Quality.