基于风险的宫癌管理指南的公平实施障碍
Cheryl R Clark1, Jacquelyn M Lykken2,3, Patricia M Chen2
1Division of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA, USA. crclark@bwh.harvard.edu.
Journal of general internal medicine
|May 30, 2025
概括
许多患者缺乏基于风险的管理所需的宫癌查史. 这突显了在护理方面的潜在不平等,特别是对于那些有保险不稳定或没有初级保健机会的人来说.
科学领域:
- 妇科瘤学 妇科瘤学
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 2019年美国结肠镜和宫病理学会 (ASCCP) 准则为异常的宫癌查结果提供基于风险的管理.
- 目前尚不清楚面临初级保健不平等的人群是否拥有必要的先前查历史,以从这些基于风险的管理策略中受益.
研究的目的:
- 确定患有异常查结果的个体中未知宫癌查史的患病率和相关性.
主要方法:
- 在华盛顿州,马萨诸塞州和德克萨斯州达拉斯县的三个不同的医疗保健系统中进行了一项回顾性,多中心,基于人口的研究.
- 数据包括25-65岁的女性,他们在2010年至2019年期间有异常的帕普细胞学或阳性人类乳头瘤病毒 (HPV) 测试 (n=63,739).
- 未知查史被定义为行政数据和电子健康记录中缺少或不足的文档.
主要成果:
- 超过三分之一的患者 (38.3%) 在异常测试之前有未知的查史.
- 在异常测试时与初级保健提供者联系的患者,未知病史的患病率较低 (PR 0.74).
- 与商业保险患者相比,没有保险的人或有多次保险过渡的人患不知病史的患病率更高 (PR 1.13).
结论:
- 对于ASCCP基于风险的指南实施至关重要的历史查数据在三个大型卫生系统中经常缺失.
- 这些发现强调了需要解决缺少数据的患者潜在的管理不平等的问题.
- 获得初级保健的障碍需要更多的关注,以确保公平的宫癌监测和护理.
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