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Improving cervical cancer prevention in a developing country
Irene Agurto1, Jorge Sandoval, Maribel De La Rosa
1Pan American Health Organization, Washington, DC 20037, USA. iagurto@yahoo.es
Summary
Continuous quality improvement and outreach strategies significantly enhanced cervical cancer screening services in El Salvador. These methods increased screening rates, reduced sample errors and wait times, and improved follow-up care for women.
Area of Science:
- Public Health
- Health Services Research
- Gynecologic Oncology
Background:
- Cervical cancer screening is crucial for early detection and prevention.
- Primary Health Care systems require effective strategies to improve service delivery and patient outcomes.
- An organized system is often lacking, necessitating innovative approaches.
Purpose of the Study:
- To enhance cervical cancer screening service delivery using continuous quality improvement (CQI) and an outreach strategy.
- To improve key performance indicators including screening rates, sample quality, turnaround time, and follow-up.
- To assess the impact of CQI and outreach in a Primary Health Care setting.
Main Methods:
- A pre- and post-intervention study was conducted in a Primary Health Care system in El Salvador.
- Four Plan-Do-Study-Act (PDSA) cycles involved policy, service provision, and community levels.
- Key outcome indicators measured were: first-time lifetime screening, unsatisfactory samples, turnaround time, and follow-up rates.
Main Results:
- 3,408 women received their first lifetime screening within one year.
- Unsatisfactory samples were reduced by 50%, and turnaround time decreased by nearly 33%.
- Follow-up rates improved from 24% to 100%. Histological confirmation showed high agreement with cytological findings for low and high-grade squamous intraepithelial lesions (L-HSIL).
Conclusions:
- Service delivery for cervical cancer screening can be significantly improved with minimal resources, even without an established organized system.
- Enhanced teamwork and coordination improved follow-up rates by strengthening links between detection and diagnosis.
- Minor adjustments and trained outreach workers improved turnaround time and connected underserved communities to health services, increasing screening access.