Follow-up of abnormal or inadequate cervical smears using two guidance systems: RCT on effectiveness.
until further notice
SourcePreventive Medicine, 41, 5-6, (2005), pp. 809-814
Article / Letter to editor
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Centre for Quality of Care Research
SubjectEBP 3: Effective Primary Care and Public Health; EBP 4: Quality of Care; N4i 3: Poverty-related infectious diseases; NCEBP 12: Human Reproduction; NCEBP 14: Cardiovascular diseases; NCEBP 3: Implementation Science; NCEBP 4: Quality of hospital and integrated care; NCEBP 7: Effective primary care and public health; ONCOL 1: Hereditary cancer and cancer-related syndromes; ONCOL 4: Quality of Care; UMCN 1.2: Molecular diagnosis, prognosis and monitoring
BACKGROUND: To improve follow-up compliance after an initial inadequate or abnormal cervical smear, two follow-up guidance systems were tested for effectiveness. A comprehensive system (cytopathology laboratory monitored the follow-up of all abnormal and inadequate smears) was compared to a selective system (monitoring was left to the smear taker; laboratory acted as a safety net). METHODS: In an RCT on all family practices (N = 171) in the catchment areas of two cytopathology laboratories (Nijmegen region, The Netherlands, 1998-2000), practices were allocated at random to one of the follow-up guidance systems. All women included were registered at the practices, invited to the national screening program and had abnormal or inadequate smears. Measurements comprised of (1) follow-up compliance at baseline and 1 year after the initial smear and (2) diagnostic outcome of the follow-up smear. RESULTS: During the study period, 132 practices sent their cervical smears to the laboratories. The comprehensive system covered 1226 women, the selective 1034. In the comprehensive system, the increase in follow-up compliance for initial inadequate and slightly abnormal smears was significantly higher (8.9%) than in the selective one, which implied an extra detection of eleven, more serious, abnormalities per 1000 women. CONCLUSION: The comprehensive system was more effective than the selective and is suitable for use on a larger scale.
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