Efforts to improve the follow-up of patients with abnormal Papanicolaou test results.

Abstract

Background: We describe and evaluate efforts to improve the follow-up care of patients with abnormal Papanicolaou test results at an academic family practice center at Shadyside Hospital in Pittsburgh. Methods: From 1994 to 1996, 1796 patients received Papanicolaou testing; 147 (8 percent) of the smears had abnormal findings—16 percent had atypia, 83 percent had dysplasia, and 1 percent had carcinoma in situ. Patients received follow-up care based on a formalized protocol using educational input, logistic aids, and automated prompting. Results: Overall follow-up success rates and colposcopy completion rates increased dramatically. Whereas 36 percent of patients with abnormal findings on Papanicolaou smears had been overdue for follow-up in 1990, only 13 percent were overdue in 1996 after our interventions. Patients assigned to Papanicolaou testing for follow-up of abnormal findings failed to receive a test in 9 of 45 (20 percent) cases, but those assigned to colposcopy follow-up failed to receive a test in only 10 of 102 (10 percent) of cases. Appointment failure rates at colposcopy clinic dropped from 56 percent in 1993 to 12 percent in 1996. Colposcopic biopsy was far superior to Papanicolaou test for detecting precursors of cervical cancer at follow-up. Conclusions: Educational programs, formalized approaches to care, transportation assistance, and reminder systems are not only practical but also can dramatically improve the outcome of cervical cancer screening programs.