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Follow-up of abnormal or inadequate cervical smears using two guidance systems: RCT on effectiveness
Rosella P M G Hermens1, Bert G Siebers, Marlies E J L Hulscher
1Centre for Quality of Care Research (WOK), Universities of Nijmegen and Maastricht, PO Box 9101, 6500 HB Nijmegen, The Netherlands. R.Hermens@kwazo.umcn.nl
Background:
To improve follow-up compliance after an initial inadequate or abnormal cervical smear, two follow-up guidance systems were tested for effectiveness. A comprehensive system (cytopathology laboratory monitored the follow-up of all abnormal and inadequate smears) was compared to a selective system (monitoring was left to the smear taker; laboratory acted as a safety net).
Methods:
In an RCT on all family practices (N = 171) in the catchment areas of two cytopathology laboratories (Nijmegen region, The Netherlands, 1998-2000), practices were allocated at random to one of the follow-up guidance systems. All women included were registered at the practices, invited to the national screening program and had abnormal or inadequate smears. Measurements comprised of (1) follow-up compliance at baseline and 1 year after the initial smear and (2) diagnostic outcome of the follow-up smear.
Results:
During the study period, 132 practices sent their cervical smears to the laboratories. The comprehensive system covered 1226 women, the selective 1034. In the comprehensive system, the increase in follow-up compliance for initial inadequate and slightly abnormal smears was significantly higher (8.9%) than in the selective one, which implied an extra detection of eleven, more serious, abnormalities per 1000 women.
Conclusion:
The comprehensive system was more effective than the selective and is suitable for use on a larger scale.