title: Specialty differences in primary care physician reports of papanicolaou test screening practices: a national survey, 2006 to 2007.
abstract: BACKGROUND
  Cervical cancer screening guidelines were substantially revised in 2002 and 2003. Little information is available about primary care physicians' current Papanicolaou (Pap) test screening practices, including initiation, frequency, and stopping.
  
  
  OBJECTIVE
  To assess current Pap test screening practices in the United States.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Nationally representative sample of physicians during 2006 to 2007.
  
  
  METHODS
  1212 primary care physicians.
  
  
  METHODS
  The survey included questions about physician and practice characteristics and recommendations for Pap screening presented as clinical vignettes describing women by age and by sexual and screening histories. A composite measure-guideline-consistent recommendations-was created by using responses to vignettes in which major guidelines were uniform.
  
  
  RESULTS
  Most physicians reported providing Pap tests to their eligible patients (91.0% [95% CI, 89.0% to 92.6%]). Among Pap test providers (n = 1114), screening practices, including number of tests ordered or performed, use of patient reminder systems, and cytology method used, varied by physician specialty (P < 0.001). Although most Pap test providers reported that screening guidelines were very influential in their clinical practice, few had guideline-consistent recommendations for starting and stopping Pap screening across multiple vignettes (22.3% [CI, 19.9% to 25.0%]). Guideline-consistent recommendations varied by specialty (obstetrics/gynecology, 16.4%; internal medicine, 27.5%; and family or general practice, 21.1%). Compared with obstetricians/gynecologists, internal medicine specialists and family or general practice specialists were more likely to have guideline-consistent screening recommendations (odds ratio, 1.98 [CI, 1.22 to 3.23] and 1.45 [CI, 0.99 to 2.13], respectively) in multivariate analysis.
  
  
  CONCLUSIONS
  Physician self-report may reflect idealized rather than actual practice.
  
  
  CONCLUSIONS
  Primary care physicians' recommendations for Pap test screening are not consistent with screening guidelines, reflecting overuse of screening. Implementation of effective interventions that focus on potentially modifiable physician and practice factors is needed to improve screening practice.
  
  
  BACKGROUND
  National Cancer Institute, Centers for Disease Control and Prevention, and Agency for Healthcare Research and Quality.
authors.affiliation: National Cancer Institute and the National Institutes of Health, Bethesda, and Information Management Services, Silver Spring, Maryland, USA. yabroffr@mail.nih.gov
authors.forename: K Robin
authors.initials: KR
authors.lastname: Yabroff
authors.forename: Mona
authors.initials: M
authors.lastname: Saraiya
authors.forename: Helen I
authors.initials: HI
authors.lastname: Meissner
authors.forename: David A
authors.initials: DA
authors.lastname: Haggstrom
authors.forename: Louise
authors.initials: L
authors.lastname: Wideroff
authors.forename: Gigi
authors.initials: G
authors.lastname: Yuan
authors.forename: Zahava
authors.initials: Z
authors.lastname: Berkowitz
authors.forename: William W
authors.initials: WW
authors.lastname: Davis
authors.forename: Vicki B
authors.initials: VB
authors.lastname: Benard
authors.forename: Steven S
authors.initials: SS
authors.lastname: Coughlin
mesh_terms: D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D019983:Guideline Adherence; D006176:Gynecology / Q000706:statistics & numerical data; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D009774:Obstetrics / Q000706:statistics & numerical data; D065006:Papanicolaou Test; D010821:Physicians, Family / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000706:statistics & numerical data*