Physician and Patient Factors Associated with Follow Up of High Grade Dysplasias of the Cervix: a Population-based Study

Objective: This population-based study characterizes available physician and patient factors involved in the follow up of abnormal Pap smear results.

Methods: Women with a first time high grade diagnosis on Pap smear between 2000 and 2005 were identified utilizing a centralized cervical screening database. Databases containing information on healthcare delivery and physician practice characteristics in a setting of universal health care were linked. Follow up is defined as referral to colposcopy or any excisional procedure associated with management of severe dysplasia. Multivariate analysis followed by logistic regression was performed addressing follow up as the dependant factor.

Results: The study population contained 43,792 women with a first time high grade cervical abnormality. The loss to follow up rate was 26%. Physician factors significantly associated with follow up included practice duration of less than 5 years OR 1.28 CI (1.09-1.5); a non-gynecologic practice was associated with lower follow up, OR 0.69 CI (0.65-0.73). Patient factors associated with lower follow up included older age OR 0.97 CI (0.97-0.98) and a lower comorbidity score OR 0.58 CI (0.48-0.7); a lower socioeconomic status was associated with a higher rate of follow up OR 1.17 CI (1.1-1.2).

Conclusions: While patient and physician factors impact appropriate follow up for women with abnormal Pap smears, none of those captured have a high level of influence other than a gynecologic practice. In order to improve upon the high loss to follow up rate, more information is needed on the practice settings of physicians and the screening program components and policies.