为患有高风险HPV和正常细胞学发现的患者提供符合指南的护理
Jasmin A Tiro1, Jacquelyn M Lykken2,3, Patricia M Chen2
1Department of Public Health Sciences, Division of the Biological Sciences, The University of Chicago, Chicago, Illinois.
JAMA network open
|January 17, 2025
概括
只有不到一半的患有高风险人类乳头瘤病毒 (HPV) 阳性结果和正常细胞学的患者及时接受了监测测试. 医疗保健系统必须改善监测和干预,以提供最佳的宫癌查.
科学领域:
- 妇科瘤学 妇科瘤学
- 公共卫生 公共卫生
- 流行病学 流行病学
背景情况:
- 美国医疗保健正在转向基于人类乳头瘤病毒 (HPV) 的宫癌查.
- 具有HPV阳性 (非16/18基因型) 结果和内皮层病变或恶性病变 (NILM) 细胞学负的患者需要特别监测.
- 目前的指导方针建议两年连续出现负面结果,恢复常规查.
研究的目的:
- 量化HPV阳性结果和NILM细胞学患者的监测测试模式.
- 评估与这些监控测试模式相关的结果.
- 确定影响及时监控测试的因素.
主要方法:
- 一项队列研究分析了PROSPR II宫协会内的METRICS (在不同环境和人群中对宫癌查过程的多层次优化) 队列的数据.
- 使用了来自美国三个不同的医疗保健系统 (Mass General Brigham,Kaiser Permanente Washington,Parkland Health) 的基于人口的数据.
- 该研究包括13,158名21-65岁的女性患者,其HPV阳性 (非-16/18) 和NILM结果从2010年1月至2018年8月,并持续到2019年12月.
主要成果:
- 只有43.7%的患者在初始HPV阳性结果的16个月内接受了监测测试.
- 在接受测试的人中,18.2%的HPV阴性/NILM结果,25.5%的结果异常.
- 与及时测试几率较低相关的因素包括年龄较小 (25-29岁),非西班牙裔黑人以及医疗补助保险;拥有初级保健医生增加了及时测试的可能性.
结论:
- 只有不到一半的HPV阳性和NILM细胞学结果的患者接受了推的年度监测测试.
- 在监测期间,显著比例的患者未经测试或失去了随访.
- 医疗保健系统需要积极监测监测的遵守情况,并实施干预措施,以改善及时进行测试,以获得最佳的宫癌预防.
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