Improving cervical cancer screening in hospital settings.
BACKGROUND
Identifying opportunities to offer cervical cancer screening to underscreened women is important for increasing early detection. Maryland law mandates offering Pap tests during hospital admissions. We examined organizational and physician attitudes and practices regarding inpatient screening, to identify mechanisms for increasing the law's effectiveness.


METHODS
We analyzed state admission data, a hospital administrators telephone survey, and a mailed survey of Maryland primary and specialty care physicians, to identify overall patterns and subgroup differences regarding screening.


RESULTS
Overall, we found significant concern regarding cancer, and evidence of policies and procedures for screening. However, most hospitals and providers offered screening without assessing clinical need or including persuasive recommendations. Providers with significantly less engagement in preventive assessment and screening included medical and surgical subspecialists and non-primary care providers. Providers to African-American and Medical Assistance women were also less likely to have knowledge, attitudes, and practices conducive to inpatient screening.


CONCLUSIONS
Adequate support and infrastructure for preventive screening exist within hospitals. Adding clinical assessment and persuasive education could in crease the impact of these mechanisms, and improve prevention among underscreened inpatient populations.
Klassen
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A
Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland 21205, USA. aklassen@jhsph.edu
Hall
A
A
Bowie
J
J
Weisman
C S
CS
D001291:Attitude of Health Personnel; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D008396:Maryland; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears