title: Improved adherence to colposcopy through nurse-led telephone counselling and multifaceted patient support.
abstract: OBJECTIVE
  In 2009, an on-site diagnostic colposcopy clinic was established within a large, urban sexual health clinic to enhance follow-up of abnormal cervical cancer screening among vulnerable women, including those who are uninsured. This service model uses a family physician colposcopist and a colposcopy nurse who provides pre-visit counselling, telephone reminders, patient-tailored ongoing support during the diagnostic process, and tracking of missed appointments. This study examined whether this program was associated with improved adherence to the first colposcopy visit after an abnormal Papanicolau smear among a high needs population.
  
  
  METHODS
  We conducted a retrospective chart review of women referred for colposcopy between January 2007 and September 2010, and examined non-adherence before (pre-group) and after (post-group) establishment of the on-site program. Univariable and multivariable logistic regression was used to examine patient and clinical factors associated with non-adherence.
  
  
  RESULTS
  Six hundred eighty-five women were referred during the study period, with 302 in the pre-group and 383 in the post-group. Non-adherence to the first colposcopy visit fell from 13% to 4% after institution of the on-site service. Pre-group status, cervical screening performed at an abortion-related visit (as opposed to a contraception or cervical screening visit), parity ≥ 1 and younger age were all associated with non-adherence in the multivariable analysis.
  
  
  CONCLUSIONS
  An on-site colposcopy service that incorporated multifaceted, client-tailored support throughout the diagnostic process significantly reduced non-attendance for an initial colposcopy visit in an urban sexual health clinic population. Broader adoption of this model could improve effectiveness of cervical cancer screening programs. However, future research should determine which specific elements of the model are more important in influencing adherence rates.
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto ON; Women's College Research Institute, Women's College Hospital, Toronto ON; Bay Centre for Birth Control, Women's College Hospital, Toronto ON.
authors.forename: Sheila
authors.initials: S
authors.lastname: Dunn
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto ON; Bay Centre for Birth Control, Women's College Hospital, Toronto ON.
authors.forename: Lea
authors.initials: L
authors.lastname: Rossiter
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto ON.
authors.forename: Jessica
authors.initials: J
authors.lastname: Ferne
authors.affiliation: Bay Centre for Birth Control, Women's College Hospital, Toronto ON.
authors.forename: Erin
authors.initials: E
authors.lastname: Barnes
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto ON.
authors.forename: Wei
authors.initials: W
authors.lastname: Wu
mesh_terms: D000328:Adult; D002170:Canada; D003127:Colposcopy / Q000379:methods / Q000523:psychology; D037001:Directive Counseling / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D015277:Hotlines; D006801:Humans; D016015:Logistic Models; D010349:Patient Compliance; D057184:Practice Patterns, Nurses'; D015397:Program Evaluation; D012189:Retrospective Studies; D012944:Social Support; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology; D014626:Vaginal Smears / Q000379:methods
keywords: adherence; colposcopy; nursing; tailored support; vulnerable populations