Reducing unnecessary Pap smears in a community clinic: Is the U.S. still over-screening for cervical cancer?
Abstract
Objective: The primary purpose of this study was to determine whether an educational intervention would result in an increased willingness of health care providers to extend the time intervals of cervical cancer screening (Papanicolau [Pap] test) among women who meet guideline criteria.
Background: The changes required of clinicians for performing appropriate Pap testing, initially introduced by American College of Obstetrician and Gynecologist to decrease unnecessary Pap testing, have encountered some translational difficulties among community clinics. When audited in January 2012, adherence to the changed guidelines by clinicians in a community clinic was only 60%.
Methods: A quasi-experimental study was designed to determine if multi-modal education would encourage adoption of the changes, as measured by increased adherence to guideline recommendations. Clinic personnel were divided into two groups for educational sessions; one consisting of providers/clinicians (N = 6) and the other consisting of medical assistants (N = 28). Fifty-two charts of patients who came to the clinic for well-woman examinations including Pap tests were reviewed to determine adherence to the guidelines to establish a baseline prior to the intervention. Fifty charts of patients who came to the clinic for well-woman examinations including Pap tests three months after the intervention were reviewed to determine the extent to which clinicians were adhering to the guidelines.
Results: After the intervention, adherence significantly improved to 90% (p = .016). Educational sessions accounted for the majority of variance occurring in the increase of appropriate and decrease in inappropriate Pap testing (p = .003).
Conclusions: This research was focused on the steps used to increase providers’ adherence to current guidelines in a community clinic setting. Eliminating unnecessary Pap smears for women who meet the criteria is cost effective, less invasive, and reduces procedures that lead to reproductive risks, complications and anxiety.
Background: The changes required of clinicians for performing appropriate Pap testing, initially introduced by American College of Obstetrician and Gynecologist to decrease unnecessary Pap testing, have encountered some translational difficulties among community clinics. When audited in January 2012, adherence to the changed guidelines by clinicians in a community clinic was only 60%.
Methods: A quasi-experimental study was designed to determine if multi-modal education would encourage adoption of the changes, as measured by increased adherence to guideline recommendations. Clinic personnel were divided into two groups for educational sessions; one consisting of providers/clinicians (N = 6) and the other consisting of medical assistants (N = 28). Fifty-two charts of patients who came to the clinic for well-woman examinations including Pap tests were reviewed to determine adherence to the guidelines to establish a baseline prior to the intervention. Fifty charts of patients who came to the clinic for well-woman examinations including Pap tests three months after the intervention were reviewed to determine the extent to which clinicians were adhering to the guidelines.
Results: After the intervention, adherence significantly improved to 90% (p = .016). Educational sessions accounted for the majority of variance occurring in the increase of appropriate and decrease in inappropriate Pap testing (p = .003).
Conclusions: This research was focused on the steps used to increase providers’ adherence to current guidelines in a community clinic setting. Eliminating unnecessary Pap smears for women who meet the criteria is cost effective, less invasive, and reduces procedures that lead to reproductive risks, complications and anxiety.
Full Text:
PDFDOI: https://doi.org/10.5430/cns.v3n4p53
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Clinical Nursing Studies
ISSN 2324-7940(Print) ISSN 2324-7959(Online)
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