The adequacy of Papanicolaou smears as performed by family physicians and obstetrician-gynecologists.
BACKGROUND
Little is known about the quality of Papanicolaou (Pap) smears performed by family physicians and obstetrician-gynecologists.


METHODS
Using hospital archival records of Pap smears performed from 1995 to 1997, we compared the quality of Pap smear sampling and the rate of detection of significant cytologic abnormalities by family physicians and obstetrician-gynecologists. Using hierarchic logistic regression, we examined the relationship between physician specialty and Pap smear reports, controlling for patient age and socioeconomic position, multiple Pap smears performed by the same clinician, and physician attending status.


RESULTS
A total of 34,916 Pap smears performed by 130 family physicians and 88 obstetrician-gynecologist residents and attending physicians were included in the analysis. There were no statistically significant differences by specialty in the rates of unsatisfactory reports (adjusted odds ratio [AOR] = 0.82; 95% confidence interval [CI], 0.48 - 1.38), satisfactory but limited reports (AOR = 1.16; 95% CI, 0.93 - 1.48), or detection rates of significant cytologic abnormalities (AOR = 0.83; 95% CI, 0.66 - 1.04). However, family physicians submitted more Pap smears with an absent endocervical component (AOR = 1.50; 95% CI, 1.07 - 2.11).


CONCLUSIONS
These findings show no significant differences by specialty in Pap smear quality as measured by rates of unsatisfactory and satisfactory but limited reports, or detection of cytologic abnormalities. The finding of higher rates of absent endocervical cells, if replicated by further study, may suggest the need for improved training of family physicians in sampling the endocervix.
Fiscella
K
K
Primary Care Institute, Highland Hospital, and the Department of Family Medicine, University of Rochester School of Medicine and Dentistry, NY, USA. Kevin_Fiscella@urmc.rochester.edu
Franks
P
P
D002983:Clinical Competence / Q000706:statistics & numerical data*; D005194:Family Practice / Q000592:standards*; D005260:Female; D006176:Gynecology / Q000592:standards*; D006764:Hospitals, Community; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D007755:Laboratories, Hospital; D008485:Medical Audit; D008505:Medical Staff, Hospital / Q000592:standards; D009518:New York; D065006:Papanicolaou Test; D014626:Vaginal Smears / Q000592:standards*