K. Robin Yabroff, PhD; Mona Saraiya, MD; Helen I. Meissner, PhD; David A. Haggstrom, MD, MAS; Louise Wideroff, PhD; Gigi Yuan, MS; Zahava Berkowitz, MSc, MSPH; William W. Davis, PhD; Vicki B. Benard, PhD; Steven S. Coughlin, PhD
Yabroff KR, Saraiya M, Meissner HI, Haggstrom DA, Wideroff L, Yuan G, et al. Specialty Differences in Primary Care Physician Reports of Papanicolaou Test Screening Practices: A National Survey, 2006 to 2007. Ann Intern Med. 2009;151:602-611. doi: 10.7326/0003-4819-151-9-200911030-00005
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Published: Ann Intern Med. 2009;151(9):602-611.
Cervical cancer screening guidelines were substantially revised in 2002 and 2003. Little information is available about primary care physicians' current Papanicolaou (Pap) test screening practices, including initiation, frequency, and stopping.
To assess current Pap test screening practices in the United States.
Nationally representative sample of physicians during 2006 to 2007.
1212 primary care physicians.
The survey included questions about physician and practice characteristics and recommendations for Pap screening presented as clinical vignettes describing women by age and by sexual and screening histories. A composite measureâ€”guideline-consistent recommendationsâ€”was created by using responses to vignettes in which major guidelines were uniform.
Most physicians reported providing Pap tests to their eligible patients (91.0% [95% CI, 89.0% to 92.6%]). Among Pap test providers (nÂ = 1114), screening practices, including number of tests ordered or performed, use of patient reminder systems, and cytology method used, varied by physician specialty (PÂ < 0.001). Although most Pap test providers reported that screening guidelines were very influential in their clinical practice, few had guideline-consistent recommendations for starting and stopping Pap screening across multiple vignettes (22.3% [CI, 19.9% to 25.0%]). Guideline-consistent recommendations varied by specialty (obstetrics/gynecology, 16.4%; internal medicine, 27.5%; and family or general practice, 21.1%). Compared with obstetricians/gynecologists, internal medicine specialists and family or general practice specialists were more likely to have guideline-consistent screening recommendations (odds ratio, 1.98 [CI, 1.22 to 3.23] and 1.45 [CI, 0.99 to 2.13], respectively) in multivariate analysis.
Physician self-report may reflect idealized rather than actual practice.
Primary care physicians' recommendations for Pap test screening are not consistent with screening guidelines, reflecting overuse of screening. Implementation of effective interventions that focus on potentially modifiable physician and practice factors is needed to improve screening practice.
National Cancer Institute, Centers for Disease Control and Prevention, and Agency for Healthcare Research and Quality.
The American College of Obstetrics and Gynecology, American Cancer Society, and U.S. Preventive Services Task Force modified their cervical cancer screening guidelines in the early 2000s to reflect new information about human papillomavirus and decreased the advised frequency of screening in some risk groups.
In 2006 to 2007, physician responses to clinical vignettes for which all guidelines agreed suggest that fewer than 25% reported guideline-consistent care. Most variations indicated overuse of screening. Guideline-consistent responses were most frequent among internists, followed by family physicians and then gynecologists.
Results are not based on actual practice behaviors.
Physicians need to better understand cervical cancer screening recommendations.
AMA = American Medical Association.
* Guideline-consistent recommendations measured when guidelines are uniform for starting or stopping Papanicolaou testing.
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