Do follow-up recommendations for abnormal Papanicolaou smears influence patient adherence?
Do follow-up recommendations for abnormal Papanicolaou smears influence patient adherence?
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DOI：
10.1001/archfami.8.6.510
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发表时间：
1999-11-01
期刊：
影响因子：
--
通讯作者：
Stewart, GK
中科院分区：
文献类型：
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作者：
Melnikow, J;Chan, BKS;Stewart, GK
目的：比较对先前巴氏涂片结果异常的女性对阴道镜检查或重复巴氏涂片的后续建议的遵守情况。设计：回顾性队列研究。地点：北加州三个计划生育诊所。患者：所有巴氏涂片结果异常的女性均转诊进行初次阴道镜检查，并随机抽样转诊进行重复巴氏涂片检查。找到并审查了转诊进行阴道镜检查的 107 名女性中的 90 名以及转诊进行重复巴氏涂片检查的 225 名女性中的 153 名患者的医疗记录。干预：应用后续电话、信件或认证信函的常规临床方案，而不考虑子宫颈抹片或推荐检查中发现的异常类型。主要结果指标：记录异常结果后 8 个月内坚持随访的情况。尝试联系患者进行随访、遵守随访建议以及从病历中提取患者特征。通过生存分析对坚持随访的概率与随访尝试次数进行建模。 Cox比例风险模型用于检查与依从性相关的多变量关系。结果：随访建议的总体依从率为56.0%（136/243）。坚持第二次阴道镜检查与重复进行巴氏涂片检查没有显着差异（比值比，1.40；95% 置信区间，0.80-2.46）。使用多达 3 条患者提醒大大提高了随访的依从性。没有保险的女性和前往 3 个诊所中的 1 个诊所就诊的女性不太可能遵守任何随访建议（无保险的风险比为 0.43 [95%；置信区间为 0.20-0.93]，诊所的风险比为 0.35 [95% 置信区间为 0.15-0.73]）。结论：无论采取哪种类型的随访，该计划生育诊所人群的随访依从性都很低。建议。通过使用最多 3 次提醒，可以提高依从性。将资源分配给有效的方法来提高异常结果随访的依从性可能比建议的随访程序更重要。
Objective: To compare adherence to follow-up recommendations for colposcopy or repeated Papanicolaou (Pap) smears for women with previously abnormal Pap smear results.Design: Retrospective cohort study.Setting: Three northern California family planning clinics.Patients: All women with abnormal Pap smear results referred for initial colposcopy and a random sample of those referred for repeated Pap smear. Medical records were located and reviewed for 90 of 107 women referred for colposcopy and 153 of 225 women referred for repeated Pap smears.Intervention: Routine clinic protocols for follow-up-telephone call, letter, or certified letter-were applied without regard to the type of abnormality seen on a Pap smear or recommended examination.Main Outcome Measures: Documented adherence to follow-up within 8 months of an abnormal result. Attempts to contact the patients for follow-up, adherence to follow-up recommendations, and patient characteristics were abstracted from medical records. The probability of adherence to follow-up vs the number of follow-up attempts was modeled with survival analysis. Cox proportional hazards models were used to examine multivariate relationships related to adherence.Results: The rate of overall adherence to follow-up recommendations was 56.0% (136/243). Adherence to a second colposcopy was not significantly different from that to a repeated Pap smear (odds ratio, 1.40; 95% confidence interval, 0.80-2.46). The use of as many as 3 patient reminders substantially improved adherence to follow-up. Women without insurance and women attending 1 of the 3 clinics were less likely to adhere to any follow-up recommendation (hazard ratio for no insurance, 0.43 [95%;, confidence interval, 0.20-0.93], and for clinic, 0.35 [95% confidence interval, 0.15-0.73]).Conclusions: Adherence to follow-up was low in this family planning clinic population, no matter what type of follow-up was advised. Adherence was improved by the use of up to 3 reminders. Allocating resources to effective methods for improving adherence to follow-up of abnormal results may be more important than which follow-up procedure is recommended.