Common Abnormal Results of Pap and Human Papillomavirus Cotesting What Physicians Are Recommending for Management
Common Abnormal Results of Pap and Human Papillomavirus Cotesting What Physicians Are Recommending for Management
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DOI：
10.1097/aog.0b013e3181fae4ca
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发表时间：
2010-12-01
影响因子：
7.2
通讯作者：
Yabroff, K. Robin
中科院分区：
文献类型：
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作者：
Berkowitz, Zahava;Saraiya, Mona;Yabroff, K. Robin
目的：评估医师和实践特征与管理指南依从性之间的关联，以更好地理解与初级保健医师不同筛查建议相关的因素。我们使用了一项全国代表性的横断面调查，调查了950名熟悉人乳头瘤病毒（HPV）的初级保健医生。通过分析对一名35岁妇女的两个临床小插曲的反应来评估对管理指南的依从性，该妇女有巴氏涂片和HPV检测结果：1）不一致（正常Pap和阳性HPV）或2）轻度异常（不确定意义的非典型鳞状细胞Pap和阴性HPV）。分析包括多变量logistic regression.Results：对于不一致的检测结果，54.3%（95%置信区间[CI] 51-57.6%）的医生建议在6-12个月内进行巴氏和HPV检测，遵守管理指南。对于轻度异常结果，只有12.2%（95%CI 10-14.7%）的患者在12个月内接受了指南推荐的巴氏试验，而没有进行HPV检测。在多变量分析中，医生的专业之间没有观察到显著差异的不一致结果。对于轻度异常结果，医师专业与指南依从性相关，其中妇产科医师依从性最高（19.8%），家庭和全科医师（9.3%）和内科医师（11%）（P
OBJECTIVE: To evaluate the association between physician and practice characteristics and adherence to management guidelines to better understand the factors associated with different screening recommendations by primary care physicians.METHODS: We used a cross-sectional nationally representative survey of 950 primary care physicians familiar with human papillomavirus (HPV) testing to assess adherence to management guidelines by analyzing responses to two clinical vignettes of a 35-year-old woman who had Pap and HPV tests results: 1) discordant (normal Pap and positive HPV) or 2) mildly abnormal (atypical squamous cells of undetermined significance Pap and negative HPV). Analyses included multivariable logistic regression.RESULTS: For the discordant test results, 54.3% (95% confidence interval [CI] 51-57.6%) of physicians recommended both Pap and HPV testing in 6-12 months, adhering to management guidelines. For the mildly abnormal results, only 12.2% (95% CI 10-14.7%) had a guideline-adherent recommendation of Pap testing in 12 months with no HPV test. In multivariable analyses, no significant difference among physicians' specialties was observed for the discordant results. For the mildly abnormal results, physician specialty was associated with guideline adherence in which obstetrician-gynecologists had the highest percent of adherence (19.8%) compared with family and general practitioners (9.3%) and internists (11%) (P