Papanicolaou screening in an urgent care setting

• Published in: American journal of obstetrics and gynecology 2005-04, Vol.192 (4), p.1084-1086
• Main Authors: Dunn, Terry S., Jazbec, Andrea, Awad, Robert, Batal, Holly
• Format: Article
• Language: English
• Subjects: Adult; Age Distribution; Aged; Biological and medical sciences; Cervical intraepithelial neoplasia; Cervical Intraepithelial Neoplasia - epidemiology; Cervical Intraepithelial Neoplasia - pathology; Cervical Intraepithelial Neoplasia - surgery; Cohort Studies; Colposcopy - methods; Cytodiagnosis - methods; Female; Female genital diseases; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; Incidence; Mass Screening - methods; Medical sciences; Middle Aged; Outpatient Clinics, Hospital; Papanicolaou smear; Papanicolaou Test; Patient Compliance; Risk Assessment; Screening visits; Treatment Outcome; Tumors; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Vaginal Smears
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2004.09.030

This study was undertaken to determine the efficacy of Papanicolaou (Pap) screening in an urgent care setting, and to compare the rates of cervical intraepithelial neoplasia (CIN), and follow-up in patients with and without established primary care. All patients presenting with a complaint warranting pelvic examination between December 2000 and September 2001 underwent Pap screening. All patients were scheduled an appointment or follow-up visit when an abnormal Pap test was found. Charts were reviewed for cytologic interpretation, age, chief complaint, ethnicity, history of prior Pap smear in the institution, total visit history (includes urgent care and primary care clinics). SAS 8.1 was used for statistical analysis with the use of the Fisher exact test. A total of 673 Pap smears were performed. Of those, 660 were analyzed and 13 were discarded because of inadequate slides. The mean age was 29.6 years; the ethnic distribution was 0.2% Native American, 1.2% Asian, 17% black, 62.4% Hispanic, 18.2% white, and 1.1% other. In the study population, only 40.6% of the patients had a prior Pap screen and 59.4% had not. There were 318 (48.2%) patients who had accessed care only through the urgent care clinic, and 342 (51.8%) patients who had established some kind of primary care in the past. The overall follow-up rate was 56% for any abnormal Pap smear, regardless of visit history. Patients accessing medical care through an urgent care clinic exclusively had identical rates of CIN and follow-up when compared with patients with established care. Therefore, when a system exists to centrally process and triage cervical cytology, it is efficacious to screen for CIN in an urgent care setting.