Risk factors for noncompliance in a colposcopy clinic

To evaluate demographic characteristics as risk factors for noncompliance with colposcopy clinic follow-up.

A retrospective, case-control study was performed on patients evaluated in the Women & Infants' Hospital colposcopy clinic between January 1, 1992, and December 31, 1993. Data extracted from chart review included demographic characteristics, insurance status, smoking status, cytologic and histologic grade treatment received, number of appointments kept and missed, number of attempts to contact the patient and degree of compliance with colposcopy follow-up. A scoring system was created to assess a patient's level of compliance by evaluating the number of appointments kept and missed.

After review of the first 80 patients, a noncompliance rate of 23% was determined based on our scoring system. A total of 86 noncompliant patients were then compared to 93 compliant patients. Women who were noncompliant with follow-up were more likely to be on Medicaid or to have no insurance when compared to compliant patients (odds ratio [OR] = 2.4, confidence interval [CI] .85, 6.7), but this difference did not reach statistical significance (P = .07). Noncompliant patients were less likely to have high grade lesions than compliant patients (OR = .34; CI .13, .85; P = .01).

Patients with lower grade lesions may be more likely to be noncompliant with recommended follow-up than patients with high grade lesions. This association may be due to a reduced emphasis on follow-up and patient education in women with low grade lesions. Increased educational efforts should be made to attempt to reduce high rates of noncompliance in this group of women.