Improving population-based cervical cancer screening in general practice: effects of a national strategy

Objective. To assess the effects of a Dutch national prevention programme, aimed at general practitioners (GPs), on the adherence to organizational gu idelines for effective cervical cancer screening in general practice. To id entify the characteristics of general practices determining success. Design. A prospective questionnaire study with pre- and post-measurement (b efore and 15 months after the introduction of the national programme). Setting and study participants. A random sample of one-third of all 4758 Du tch general practices. One GP was asked to participate per practice. Intervention. A national GP prevention programme to improve population-base d prevention of cervical cancer combining various methods for quality impro vement in general practice, performed on a national, district and practice level. Outreach visitors were a key strategy in bringing about behavioural changes. Main outcome measures. The proportion of practices adhering to 10 recommend ations (in four guidelines) to organize effective cervical cancer screening . Results. After 15 months, all Dutch practices showed significant improvemen t in adherence to nine out of 10 recommendations. Two recommendations, in p articular 'identifying women who should be medically excluded from screenin g' and 'sending a reminder to non-compilers' showed the largest absolute in creases of 26% and 33%, respectively Besides more intensive support of outr each visitors, practice characteristics such as 'computerization' and 'dele gation of many clinical tasks to the practice assistant' were important in improving the adherence to guidelines. Conclusion. The national programme, with a combination of various methods f or quality improvement, appeared to be effective in improving the organizat ion of cervical screening in general practice. Computerization and, to a le sser extent, delegation of many clinical tasks to the practice assistant an d more intensive support to practices, positively influenced the effectiven ess of the national programme.