Predictors of follow-up of atypical and ASCUS papanicolaou tests in a high-risk population.
OBJECTIVE
Our goals were to assess adherence to the National Cancer Institute clinical practice guideline for the management of atypical squamous cells of uncertain significance (ASCUS) Papanicolaou (Pap) test results in a community at high risk of cervical cancer. We also hoped to identify predictors of adherence to the guideline.


METHODS
We used an historical cohort and collected data by chart abstraction.


METHODS
Our study included women receiving care in 7 urban community health centers who had an initial ASCUS or atypical Pap test result in 1996. We excluded women with a history of cervical dysplasia or human immunodeficiency virus infection, yielding a final sample of 387 women.


RESULTS
measured The outcome measured was the level of adherence to the guideline, defined as falling within 1 of 3 mutually exclusive categories (complete, moderate, or low).


RESULTS
Care providers recommended colposcopy after an initial atypical Pap test result in 12% of cases and repeat cytology in 67%. Failure to document a plan for management was found in 19% of cases. Complete adherence was achieved for 27% of subjects, moderate adherence for 28%, and low adherence for 45%. The factors associated with complete versus moderate or low adherence included site of care, description of the abnormality (ASCUS vs atypia), availability of on-site colposcopy, and discussing the plan at a visit.


CONCLUSIONS
Adherence with the National Cancer Institute clinical practice guideline in this setting was disappointing and varied substantially by site. Factors amenable to change that may improve follow-up include good communication of results with patients and providing colposcopy at the site of primary care.
McKee
M D
MD
Dept of Family Medicine & Community Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA. mckee@aecom.yu.edu
Schechter
C
C
Burton
W
W
Mulvihill
M
M
D015331:Cohort Studies; D003127:Colposcopy; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D065006:Papanicolaou Test; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D019037:Urban Health Services; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D014626:Vaginal Smears