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Primary care endometrial sampling for abnormal uterine bleeding: a pilot study
Jon M Dickson1, Brigitte Delaney1, Mary E Connor2
1The University of Sheffield, The Academic Unit of Primary Medical Care, Northern General Hospital, Sheffield, UK.
Aim:
To design and evaluate a pilot service for primary care endometrial sampling (PCES).
Design:
Retrospective analysis of data from two service evaluations.
Setting:
General practices and the gynaecology department in a large city in the UK.
Methods:
These were two-fold: (1) To design the new service we identified all the endometrial samples taken in the city's gynaecology department in 2012/2013 and estimated the proportion of these with abnormal uterine bleeding (AUB) that would be suitable for PCES. (2) To evaluate the new PCES service we analysed data from the first year of activity.
Results:
(1) A total of 1894 endometrial samples were taken in hospital in 2012/2013. An estimated 424 (22.4%) of these were from patients with AUB who fitted the criteria for PCES. (2) In the first year of the PCES service 108 samples were taken by general practitioners (GPs). Initial management of these patients was exclusively in primary care in 97.2% (104/108) of cases; most patients were treated with the Mirena intrauterine system (79/109; 73.1%) and there were no cases of hyperplasia or cancer.
Conclusions:
Most premenopausal patients with AUB could potentially be managed in primary care without referral to hospital if endometrial sampling (ES) was made available to appropriately trained and supported GPs. However, this study was limited by its retrospective, non-interventional design, and more research is required to demonstrate safety and cost-effectiveness.
