Clinical recommendations for Pap test screening not consistent with screening guidelines

Less than a quarter of primary care providers employed Papanicolaou test recommendations that were consistent with screening guidelines, according to results of a recent study.

Researchers surveyed 1,212 primary care physicians in the United States on Pap test screening practice characteristics and recommendations. The study duration was 2006 to 2007.

Physicians were presented with hypothetical clinical situations involving women of varying ages and sexual and screening histories. The researchers created a composite measure — guideline-consistent recommendations — using responses to the situations in which major guidelines were uniform.

The results indicated that 91% of the physicians who were surveyed reported administering Pap tests to eligible patients (95% CI, 89.0%-92.6%).

Depending on physician specialty, variations were observed in use of patient reminder systems, cytology method used and screening practices, including the number of tests ordered and performed (P<.001).

Guideline-consistent recommendations for Pap tests were employed by the following proportion of specialists: obstetrics/gynecology, 16.4%; internal medicine, 27.5%; and family or general practice, 21.1%.

Most Pap test providers reported that screening guidelines strongly influenced clinical practice. However, only 22.3% of those providers had recommendations for starting and stopping Pap screening across multiple vignettes that were consistent with recommendations (95% CI, 19.9%-25%).

Compared with obstetricians/gynecologists, internal medicine specialists were almost twice as likely to have guideline-consistent screening recommendations (OR=1.98; 95% CI, 1.22-3.23). Family or general practice specialists also were more likely than obstetricians/gynecologists to have guideline-consistent screening recommendations (OR=1.45; 95% CI, .99-2.13).

Yabroff KR. Ann Intern Med. 2009;151:602-611.