Quality, access, and clinical issues in a nurse practitioner colposcopy outreach program.
From 8/89 to 7/92 a NP-colposcopist performed 593 colposcopy examinations including cervical biopsies, endocervical curettages, and Pap smears. Procedures were performed in selected health departments in north-central Florida. This portable outreach program expanded services to a primarily rural, medically indigent population. Specimen results were 21.1% negative, 5.6% human papilloma virus (HPV) only, 37.3% CIN I, 17.4% CIN II, 11.9% CIN III, 2.4% CIS, 0.3% carcinoma, and 4% other. Many CIN lesions also included HPV, yielding an overall incidence of HPV at 62.7%. Using the Bethesda system, 42.8% were low grade lesions, 32.1% high grade. Fourteen cases of CIS and two of carcinoma (one invasive, one microinvasive) were found. An 87.7% colposcopic diagnostic acumen level is favorable compared with published physician studies. One third of undercalls were due to occult canal lesions. Significant risk factors were smoking (48.6%), first coitus at < 18 years old (74%), history of HPV (49.6%), and life-time sexual partners > 2 (61.3%). Holistic prevention enabled 209 non-colposcopy problems.
Gifford
M S
MS
University of Florida College of Medicine, North Central Florida Maternity and Infant Care Project Division.
Stone
I K
IK
D000293:Adolescent; D000328:Adult; D000368:Aged; D003127:Colposcopy / Q000592:standards; D005260:Female; D005431:Florida / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D008489:Medical Indigency; D008507:Medically Underserved Area; D008875:Middle Aged; D009722:Nurse Practitioners / Q000592:standards; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000473:pathology; D011446:Prospective Studies; D011787:Quality of Health Care; D012307:Risk Factors; D014412:Tumor Virus Infections / Q000453:epidemiology / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000473:pathology