Exploring loss to follow-up: abnormal Pap screening in Hispanic patients.
OBJECTIVE
The loss of patients to follow-up for abnormal findings from Pap screenings is an important public health concern, particularly among poor and minority women. This study explores factors affecting incomplete follow-up among a group of Hispanic women with low incomes.


METHODS
A qualitative descriptive study was conducted of 11 Hispanic patients with incomplete Pap smear follow-up at a public clinic in a major city in south Texas. Patients were interviewed using a semistructured, open-ended schedule of questions, and their medical records were abstracted. The clinic's five staff members also were interviewed. Comparative chronologies were constructed for each case, contrasting patient and staff accounts of the same set of events. All data were coded by at least two investigators.


RESULTS
All study patients had mildly abnormal Pap smear results and had not met the follow-up criteria, but all understood and were committed to Pap screening. Although viewed by staff as noncompliant, none of the patients viewed her behavior this way. This staff-patient discrepancy was attributable to poor communication, mixed messages, clinic errors, and, perhaps most importantly, to a conflict between program policies and the specific circumstances of individual cases. Two case examples are presented to illustrate key points.


CONCLUSIONS
Strategies that may help to reduce loss to follow-up among similar patients include the following: allowing clinic staff more flexibility in follow-up procedures for women who have consistently normal follow-up tests, including Spanish translations of written messages; enlisting patients' agreement in setting appointments; and updating patient records to reflect follow-up care that had been received in other clinics.
Hunt
Linda M
LM
Department of Anthropology and Julian Samora Research Institute, Michigan State University, East Lansing, Michigan 48824, USA.
De Voogd
Katherine B
KB
Soucy
Mark D
MD
Longworth
Judith C
JC
D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D009732:Nursing Care; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D011203:Poverty; D013781:Texas; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014626:Vaginal Smears