title: Inconsistencies between medical records and patient-reported recommendations for follow-up after abnormal Pap tests.
abstract: OBJECTIVE
  Adherence with recommended follow-up after an abnormal Pap test is a critical step in the prevention of cervical cancer. Here, we focused on identifying inconsistencies between self-reported and health department record recommendations for follow-up.
  
  
  METHODS
  Self-reported recommendations for follow-up were collected by questionnaire from 519 women with abnormal Pap tests in rural Appalachia as part of a trial of the efficacy of patient navigation. Health department medical records were reviewed to collect healthcare provider recommendations. Measures of inconsistency (discordance) were calculated for overall recommendations and each of three particular follow-up recommendations: repeat Pap test, referral for further tests, and other gynecologist referral.
  
  
  RESULTS
  The inconsistencies between the recommendation from the health department records and self-reports ranged from 15.0% (repeat Pap test) to 35.3% (gynecologist referral). Inconsistencies were most common among women with a history of abnormal Pap tests and those with more severe initial results. Recommendations for repeat Pap tests were correctly reported most often when the women recalled receiving a letter stating the results. Of greatest concern were the inconsistencies regarding recommendations for referral to a gynecologist. The more severe the Pap test result, the greater the odds of inaccurate self-reports of receiving a referral to a gynecologist for follow-up, p<0.001.
  
  
  CONCLUSIONS
  Clinicians should be aware that patients with a history of abnormal results and severe Pap test abnormalities are at risk of misreporting recommendations for follow up.
authors.affiliation: University of Kentucky, Lexington, KY, USA. Stacey.Slone@uky.edu
authors.forename: Stacey
authors.initials: S
authors.lastname: Slone
authors.forename: Carol
authors.initials: C
authors.lastname: White
authors.forename: Brent
authors.initials: B
authors.lastname: Shelton
authors.forename: Emily
authors.initials: E
authors.lastname: Van Meter
authors.forename: Christopher
authors.initials: C
authors.lastname: DeSimone
authors.forename: Nancy
authors.initials: N
authors.lastname: Schoenberg
authors.forename: Mark
authors.initials: M
authors.lastname: Dignan
mesh_terms: D000293:Adolescent; D000328:Adult; D016000:Cluster Analysis; D003266:Continuity of Patient Care; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D006779:Hospitals, Public; D006801:Humans; D007629:Kentucky; D008499:Medical Records / Q000706:statistics & numerical data*; D008875:Middle Aged; D010349:Patient Compliance; D062526:Patient Navigation; D012017:Referral and Consultation / Q000706:statistics & numerical data; D019035:Rural Health Services; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D055815:Young Adult