USING PATIENT AND GENERAL-PRACTICE CHARACTERISTICS TO EXPLAIN VARIATIONS IN CEI CERVICAL SMEAR UPTAKES RATES

Objectives-To produce practice and patient variables for general pract ices from census and family health services authority data, and to det ermine the importance of these variables in explaining variation in ce rvical smear uptake rates between practices. Design-Population based s tudy examining variations in cervical smear uptake rates among 126 gen eral practices using routine data. Setting-Merton, Sutton, and Wandswo rth Family Health Services Authority, which covers parts of inner and outer London. Main outcome measure-Percentage of women aged 25-64 year s registered with a general practitioner who had undergone a cervical smear test during the five and a half years preceding 31 March 1992. R esults-Cervical smear uptake rates varied from 16.5% to 94.1%. The est imated percentage of practice population from ethnic minority groups c orrelated negatively with uptake rates (r=-0.42), as did variables ass ociated with social deprivation such as overcrowding (r=-0.42), not ow ning a ear (r=-0.41), and unemployment (r=-0.40). Percentage of practi ce population under 5 years of age correlated positively with uptake r ate (r=0.42). Rates were higher in practices with a female partner tha n in those without (66.6% v 49.1%; difference 17.5% (95% confidence in terval 10.5% to 24.5%)), and in computerised than in non-computerised practices (64.5% v 50.5%; 14.0% (6.4% to 21.6%)). Rates were higher in larger practices. In a stepwise multiple regression model that explai ned 52% of variation, five factors were significant predictors of upta ke rates: presence of a female partner; children under 5; overcrowding ; number of women aged 35-44 as percentage of all women aged 25-64; ch ange of address in past year. Conclusions-Over half of variation in ce rvical smear uptake rates can be explained by patient and practice var iables derived from census and family health services authority data; these variables may have a role in explaining variations in performanc e of general practices and in producing adjusted measures of practice performance. Practices with a female partner had substantially higher uptake rates.