Cervical cancer screening in the urgent care setting |
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Authors: | Dr Holly Batal MD Stacy Biggerstaff MS Terry Dunn MD Philip S Mehler MD |
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Institution: | (1) the Urgent Care Clinic at Denver Health and Department of Medicine, the University of Colorado Health Sciences Center, Denver, Colo;(2) the Colorado Prevention Center, Denver, Colo;(3) the Women’s Care Clinic at Denver Health and Department of Obstetrics and Gynecology, the University of Colorado Health Sciences Center, Denver, Colo;(4) Division of General Internal Medicine at Denver Health and Department of Medicine, the University of Colorado Health Sciences Center, Denver, Colo;(5) Denver Health Medical Center, 777 Bannock St., MC0107, 80204 Denver, CO |
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Abstract: | OBJECTIVE: To determine the feasibility of cervical cancer screening in an urgent care clinic.
DESIGN: Prospective randomized trial.
SETTING: Public teaching hospital.
PATIENTS: Women presenting to the urgent care clinic whose evaluation necessitated a pelvic examination were eligible for participation.
Women who had a hysterectomy, had a documented Pap test at our institution in the past year, did not speak English or Spanish,
or had significant vaginal bleeding were excluded. Women presenting to the gynecology clinic for a scheduled Pap test were
used as a comparison group for rates of follow-up, Pap smear adequacy, and Pap smear abnormalities.
INTERVENTIONS: Women randomized to the intervention group had a Pap test performed as part of their pelvic examination, while women in the
usual care group were encouraged to schedule an appointment in the gynecology clinic at a later date. The women in the two
groups completed identical questionnaires regarding cervical cancer risk factors and demographic information.
MEASUREMENTS AND MAIN RESULTS: Ninety-four (84.7%) of 111 women in the intervention group received a Pap test, as compared with 25 (29%) of 86 in the usual
care group (P<.01). However, only 5 (24%) of 21 women with abnormal Pap smears in the intervention group received follow-up compared with
6 (60%) of 10 women seen during the same time period in the gynecology clinic for self-referred, routine annual examinations
(P=.11). Pap smears obtained in the urgent care clinic were similar to those in the gynecology clinic with regard to abnormality
rate (22.3% vs 20%; P=.75, respectively) and specimen adequacy (67% vs 72%; P=.54, respectively).
CONCLUSIONS: Urgent care clinic visits can be used as opportunities to perform Pap test screening in women who are unlikely to adhere
to cervical cancer screening recommendations. However, to accure the full potential benefit from this intervention, an improved
process to ensure patient follow-up must be developed.
Presented at the Society of General Internal Medicine annual meeting, San Francisco, Calif, May 1, 1999
Funding for this research was provided by the Division of General Internal Medicine, University of Colorado Health Sciences
Center. |
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Keywords: | cervical cancer screening urgent care clinic Pap smears |
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