title: Follow-up of abnormal or inadequate cervical smears using two guidance systems: RCT on effectiveness.
abstract: BACKGROUND
  To improve follow-up compliance after an initial inadequate or abnormal cervical smear, two follow-up guidance systems were tested for effectiveness. A comprehensive system (cytopathology laboratory monitored the follow-up of all abnormal and inadequate smears) was compared to a selective system (monitoring was left to the smear taker; laboratory acted as a safety net).
  
  
  METHODS
  In an RCT on all family practices (N = 171) in the catchment areas of two cytopathology laboratories (Nijmegen region, The Netherlands, 1998-2000), practices were allocated at random to one of the follow-up guidance systems. All women included were registered at the practices, invited to the national screening program and had abnormal or inadequate smears. Measurements comprised of (1) follow-up compliance at baseline and 1 year after the initial smear and (2) diagnostic outcome of the follow-up smear.
  
  
  RESULTS
  During the study period, 132 practices sent their cervical smears to the laboratories. The comprehensive system covered 1226 women, the selective 1034. In the comprehensive system, the increase in follow-up compliance for initial inadequate and slightly abnormal smears was significantly higher (8.9%) than in the selective one, which implied an extra detection of eleven, more serious, abnormalities per 1000 women.
  
  
  CONCLUSIONS
  The comprehensive system was more effective than the selective and is suitable for use on a larger scale.
authors.affiliation: Centre for Quality of Care Research (WOK), Universities of Nijmegen and Maastricht, PO Box 9101, 6500 HB Nijmegen, The Netherlands. R.Hermens@kwazo.umcn.nl
authors.forename: Rosella P M G
authors.initials: RP
authors.lastname: Hermens
authors.forename: Bert G
authors.initials: BG
authors.lastname: Siebers
authors.forename: Marlies E J L
authors.initials: ME
authors.lastname: Hulscher
authors.forename: Jozé C C
authors.initials: JC
authors.lastname: Braspenning
authors.forename: Jan H M
authors.initials: JH
authors.lastname: van Doremalen
authors.forename: Antonius
authors.initials: A
authors.lastname: Hanselaar
authors.forename: Richard P T M
authors.initials: RP
authors.lastname: Grol
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
mesh_terms: D005260:Female; D006801:Humans; D009313:National Health Programs; D009426:Netherlands; D010349:Patient Compliance; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears