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Barriers to Follow-up of Abnormal Papanicolaou Smears in an Urban Community Health Center
M. Diane McKee, MD;
Joseph Lurio, MD;
Paul Marantz, MD, MPH;
William Burton, MA;
Michael Mulvihill, DrPH
Arch Fam Med. 1999;8:129-134.
Objective To determine factors predictive of failure to return for colposcopy among women with significant abnormalities on Papanicolaou smears in a high-risk clinical population.
Design Telephone survey.
Setting An urban community health center.
Participants Two hundred seventy-nine women randomly selected from all women seen at the health center with abnormal Papanicolaou smears requiring colposcopy during 1993 to 1994. Six (2%) refused participation, and 19% could not be reached for inclusion. Subjects were mostly minority women receiving Medicaid.
Main Outcome Measure Completion of colposcopy.
Results Of the 279 selected women, 79% were interviewed. The rate of adherence with colposcopy was 75% for the respondents. Women who did not know the results of their smear or who incorrectly understood their results were significantly less likely to return for colposcopy (P=.001). Younger women, especially teenagers, were less likely to return (P=.02). Socioeconomic status, education, primary language, health beliefs, fear of cancer, and clinician's gender or discipline were not associated with rate of follow-up. Barriers involving transportation, child care, and insurance also did not predict follow-up.
Conclusions Effective communication of results is the most important factor related to follow-up after abnormal Papanicolaou smear in this setting. In other settings, other factors may be of greater importance.
From the Departments of Family Medicine (Drs McKee, Lurio, and Mulvihill and Mr Burton) and Epidemiology and Social Medicine (Dr Marantz), Albert Einstein College of Medicine, Bronx, NY.
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