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Papanicolaou screening in an urgent care setting
Terry S Dunn1, Andrea Jazbec, Robert Awad
1Denver Health Medical Center, 777 Bannock St, Denver, CO 80204, USA. Tdunn@dhha.org
Insights
Urgent care Papanicolaou (Pap) screening is effective for detecting cervical intraepithelial neoplasia (CIN) and ensuring follow-up. Patients using only urgent care had similar CIN rates and follow-up as those with primary care.
Area of Science:
- Gynecology
- Public Health
- Preventive Medicine
Background:
- Papanicolaou (Pap) screening is crucial for cervical cancer prevention.
- Urgent care settings offer accessible healthcare but their role in routine screening is debated.
- Understanding screening efficacy in urgent care is vital for public health strategies.
Purpose of the Study:
- To evaluate the effectiveness of Pap screening in urgent care.
- To compare cervical intraepithelial neoplasia (CIN) detection and follow-up rates.
- To assess differences between patients with and without established primary care.
Main Methods:
- Pap screening was performed on patients needing pelvic exams between December 2000 and September 2001.
- Follow-up was scheduled for abnormal Pap tests.
- Chart review analyzed cytologic results, demographics, and visit history; Fisher exact test was used for statistics.
Main Results:
- 660 Pap smears were analyzed; mean age was 29.6 years.
- 40.6% had prior Pap screens; 59.4% did not.
- Overall follow-up for abnormal Pap smears was 56%.
Conclusions:
- Urgent care Pap screening yielded comparable CIN rates and follow-up to primary care.
- Effective triage systems make urgent care a viable setting for cervical cytology screening.
- This supports integrating Pap screening into urgent care services.
Objective:
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.
Study Design:
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.
Results:
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.
Conclusion:
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.