Low-income minority women at risk for cervical cancer: a process to improve adherence to follow-up recommendations.
OBJECTIVE
The Houston Department of Health and Human Services (HDHHS) has a centralized process for notifying and setting up follow-up appointments for women with abnormal Pap smears who are clients of HDHHS health centers. Faculty and a student from the University of Texas School of Public Health and HDHHS personnel jointly conducted a study to evaluate the process and performance of the system.


METHODS
The study examined two subpopulations: women with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions (ASCUS/LGSIL) and women with high-grade squamous intraepithelial lesions or atypical glandular cells of undetermined significance (HGSIL/AGCUS). A retrospective study was conducted of data on women attending eight HDHHS clinics during the period from February 1996 through August 2000. Records of 1,216 women referred for evaluation of abnormal Pap smears were reviewed. Process effectiveness was measured by the number of successful contacts made and the number of appointments set up. Performance was measured by compliance with referral appointments. Predictors included race/ethnicity, age, co-existence of a sexually transmitted disease, number of prior referrals, type of patient visit, and health center attended.


RESULTS
HDHHS staff successfully notified 95.6% of women with ASCUS/LGSIL and 97.9% of women with HGSIL/AGCUS. Using performance criteria as outcome measures, high-risk women requiring targeted interventions were identified. Overall, 84.2% of women scheduled appointments. Among those with ASCUS/LGSIL, women identified as African American were 53% less likely to accept an appointment and 45% less likely to show up for the appointment than those identified as Hispanic or "other." Age and type of patient visit appeared to be significantly associated with patient compliance behavior.


CONCLUSIONS
The study describes the effectiveness of a centralized patient follow-up process for women at risk for cervical cancer.
University of Texas School of Public Health, PO Box 20186, Houston, TX 77225, USA.
V A
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Cardin
R M
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Grimes
Z D
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Jiang
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Pomeroy
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Harrell
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Cano
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology; D000465:Algorithms; D001071:Appointments and Schedules; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000208:ethnology; D003151:Community Health Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D018672:Community Health Planning / Q000458:organization & administration*; D018450:Disease Progression; D005260:Female; D006302:Health Services Research; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D008913:Minority Groups / Q000523:psychology* / Q000706:statistics & numerical data; D065006:Papanicolaou Test; D010349:Patient Compliance / Q000208:ethnology*; D011203:Poverty / Q000208:ethnology*; D017064:Process Assessment, Health Care; D011635:Public Health Administration; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D012307:Risk Factors; D012581:Schools, Public Health; D013781:Texas / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D016387:Women's Health; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000208:ethnology