Low-Risk Human Papillomavirus Testing and Other Nonrecommended Human Papillomavirus Testing Practices Among US Health Care Providers
Low-Risk Human Papillomavirus Testing and Other Nonrecommended Human Papillomavirus Testing Practices Among US Health Care Providers
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DOI：
10.1097/aog.0b013e3182210034
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发表时间：
2011-07-01
影响因子：
7.2
通讯作者：
Saraiya, Mona
中科院分区：
文献类型：
--
作者：
Lee, Jennifer Wai-Yin;Berkowitz, Zahava;Saraiya, Mona
目的：评估卫生保健提供者和诊所自我报告的人乳头瘤病毒（HPV） DNA检测实践，包括非推荐的实践，如低风险HPV检测，30岁以下女性的HPV共检测，以及用于高度异常巴氏试验结果的HPV反射检测。方法：我们结合2006年全国门诊医疗调查和全国医院门诊医疗调查，分析了对全国代表性样本Papanicolaou检测提供者的横断面调查的反应。对376个办公室医疗保健提供者和216个门诊诊所的答复进行数据分析。结果：总体而言，75.5%（95%置信区间[CI] 68.7-81.2%）的卫生保健提供者和77.2%（95%置信区间[CI] 60.3-88.3%）的诊所报告曾使用HPV DNA检测。在使用HPV检测的卫生保健提供者中，28.5% （95% CI 21.6-36.6%）同时使用高危和低危HPV检测。大多数卫生保健提供者（59.6%,95% CI 48.5-69.7%）和诊所（66.0%,95% CI 48.0-80.3%）在30岁以下女性中使用HPV共同检测。很高比例的卫生保健提供者和诊所在巴氏涂片检查结果为非典型鳞状细胞后进行反射性HPV检测，不能排除高级别鳞状上皮内病变（分别为71.4%,95% CI 63.5-78.3%和62.8%,95% CI 49.0-74.9%）和高级别鳞状上皮内病变（分别为50.7%,95% CI 42.4-58.9%和49.0%,95% CI 33.1-65.2%），这些结果不建议进行HPV检测。结论：许多卫生保健提供者报告了HPV检测的不当使用，这可能导致不必要的随访和增加的医疗费用，而没有额外的好处。干预措施，如从美国市场取消低风险HPV检测，教育卫生保健提供者和患者HPV检测的适当适应症，需要阻止卫生保健提供者这样做。（journal of gynecology, 2011;118:4-13） DOI: 10.1097/AOG.0b013e3182210034
OBJECTIVE: To assess self-reported human papillomavirus (HPV) DNA testing practices by health care providers and clinics, including nonrecommended practices such as low-risk HPV testing, HPV cotesting in women younger than age 30 years, and HPV reflex testing for high-grade abnormal Pap test results.METHODS: We analyzed responses to a cross-sectional survey of a nationally representative sample of Papanicolaou test providers administered in conjunction with the 2006 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Data analysis was performed on responses from 376 office-based health care providers and 216 outpatient clinics.RESULTS: Overall, 75.5% (95% confidence interval [CI] 68.7-81.2%) of health care providers and 77.2% (95% CI 60.3-88.3%) of clinics reported ever using the HPV DNA test. Of health care providers who used HPV testing, 28.5% (95% CI 21.6-36.6%) used both high-risk and low-risk HPV tests. Most health care providers (59.6%, 95% CI 48.5-69.7%) and clinics (66.0%, 95% CI 48.0-80.3%) used HPV cotesting in women younger than age 30 years. A high percentage of health care providers and clinics performed reflex HPV testing after Pap test results of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (71.4%, 95% CI 63.5-78.3% and 62.8%, 95% CI 49.0-74.9%, respectively) and high-grade squamous intraepithelial lesions (50.7%, 95% CI 42.4-58.9% and 49.0%, 95% CI 33.1-65.2%, respectively), results for which HPV testing is not recommended.CONCLUSION: Many health care providers reported inappropriate uses of HPV testing, which may lead to unnecessary follow-up and increased medical costs without added benefits. Interventions such as eliminating the low-risk HPV test from the U. S. market and educating health care providers and patients on appropriate indications for HPV testing are needed to discourage health care providers from such practices. (Obstet Gynecol 2011;118:4-13) DOI: 10.1097/AOG.0b013e3182210034