Reduction in Unindicated Cervical Cancer Screening in Adolescents in a Large Health Care System.

IF 2.4 4区医学 Q2 OBSTETRICS & GYNECOLOGY Journal of Lower Genital Tract Disease Pub Date : 2024-07-23 DOI:10.1097/LGT.0000000000000831

Bertie Geng, Carlos R Oliveira, Hillary Hosier, Sangini S Sheth, Alla Vash-Margita

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Abstract

Objectives/purpose: Evidence-based guidelines recommend against screening for cervical cancer (Pap testing) in average-risk adolescents <21 years old. Despite this, many still undergo unindicated screenings with subsequent detrimental reproductive health and economic consequences. Our aim was to reduce unindicated cervical cancer screening in individuals <21 years old in a large health care system by utilizing an electronic provider notification.

Methods: Starting in July 2020, a Best Practice Advisory (BPA) appeared in the electronic medical record (EMR) if providers ordered Pap testing on individuals <21 years old. This BPA reiterated that screening was not indicated for average-risk adolescents and prompted users to choose an indication if they wanted to proceed.A retrospective chart review, pre/post intervention study was performed comparing individuals <21 years old with Pap testing performed before and after intervention (January 2019-June 2020 and July 2020-June 2021, respectively). Patient characteristics were extracted from the EMR and analyzed using Fisher exact tests, Kruskal-Wallis tests, and logistic regression.

Results: There were 140 subjects included: 106 preintervention and 34 postintervention. There were no differences in baseline characteristics. Neither Pap nor human papillomavirus testing results differed between the groups. Preintervention, 6.6% of cytology tests were indicated compared to 20.6% postintervention ( p = .042). The proportion of indicated human papillomavirus testing did not differ preintervention and postintervention at 65% and 45%, respectively ( p = .295). The overall reduction in unindicated cervical cancer screening postintervention was 13.9% (95% CI = 4.0-23.7).

Conclusions: We demonstrated that incorporating a BPA to the EMR reduces unindicated cervical cancer screening.

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减少大型医疗保健系统中青少年未指定的宫颈癌筛查。

目标/目的：循证指南建议不要对一般风险的青少年进行宫颈癌筛查（巴氏涂片检查）方法：从 2020 年 7 月开始，如果医疗服务提供者要求对个人进行巴氏涂片检查，电子病历（EMR）中将出现最佳实践建议（BPA）：自 2020 年 7 月起，如果医疗服务提供者要求对个人进行巴氏涂片检查，电子病历（EMR）中将显示最佳实践建议（BPA）：共纳入 140 名受试者：干预前 106 人，干预后 34 人。基线特征无差异。两组的巴氏试验和人类乳头瘤病毒检测结果均无差异。干预前，6.6%的细胞学检测结果为有指征，而干预后为 20.6%（P = 0.042）。有指征的人类乳头瘤病毒检测比例在干预前和干预后没有差异，分别为 65% 和 45%（p = .295）。干预后，未指定的宫颈癌筛查率总体下降了 13.9% (95% CI = 4.0-23.7)：我们证明，在电子病历中加入 BPA 可减少未指定的宫颈癌筛查。

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来源期刊

Journal of Lower Genital Tract Disease OBSTETRICS & GYNECOLOGY-

CiteScore

6.80

自引率

8.10%

发文量

158

审稿时长

6-12 weeks

期刊介绍： The Journal of Lower Genital Tract Disease is the source for the latest science about benign and malignant conditions of the cervix, vagina, vulva, and anus. The Journal publishes peer-reviewed original research original research that addresses prevalence, causes, mechanisms, diagnosis, course, treatment, and prevention of lower genital tract disease. We publish clinical guidelines, position papers, cost-effectiveness analyses, narrative reviews, and systematic reviews, including meta-analyses. We also publish papers about research and reporting methods, opinions about controversial medical issues. Of particular note, we encourage material in any of the above mentioned categories that is related to improving patient care, avoiding medical errors, and comparative effectiveness research. We encourage publication of evidence-based guidelines, diagnostic and therapeutic algorithms, and decision aids. Original research and reviews may be sub-classified according to topic: cervix and HPV, vulva and vagina, perianal and anal, basic science, and education and learning. The scope and readership of the journal extend to several disciplines: gynecology, internal medicine, family practice, dermatology, physical therapy, pathology, sociology, psychology, anthropology, sex therapy, and pharmacology. The Journal of Lower Genital Tract Disease highlights needs for future research, and enhances health care. The Journal of Lower Genital Tract Disease is the official journal of the American Society for Colposcopy and Cervical Pathology, the International Society for the Study of Vulvovaginal Disease, and the International Federation of Cervical Pathology and Colposcopy, and sponsored by the Australian Society for Colposcopy and Cervical Pathology and the Society of Canadian Colposcopists.