Do follow-up recommendations for abnormal Papanicolaou smears influence patient adherence?

Objective: To compare adherence to follow-up recommendations for colposcopy or repeated Papanicolaou (Pap) smears for women with previously abnormal P ap smear results. Design: Retrospective cohort study. Setting: Three northern California family planning clinics. Patients: All women with abnormal Pap smear results referred for initial co lposcopy and a random sample of those referred for repeated Pap smear. Medi cal records were located and reviewed for 90 of 107 women referred for colp oscopy and 153 of 225 women referred for repeated Pap smears. Intervention: Routine clinic protocols for follow-up-telephone call, letter , or certified letter-were applied without regard to the type of abnormalit y seen on a Pap smear or recommended examination. Main Outcome Measures: Documented adherence to follow-up within 8 months of an abnormal result. Attempts to contact the patients for follow-up, adhere nce to follow-up recommendations, and patient characteristics were abstract ed from medical records. The probability of adherence to follow-up vs the n umber of follow-up attempts was modeled with survival analysis. Cox proport ional hazards models were used to examine multivariate relationships relate d to adherence. Results: The rate of overall adherence to follow-up recommendations was 56. 0% (136/243). Adherence to a second colposcopy was not significantly differ ent from that to a repeated Pap smear (odds ratio, 1.40; 95% confidence int erval, 0.80-2.46). The use of as many as 3 patient reminders substantially improved adherence to follow-up. Women without insurance and women attendin g 1 of the 3 clinics were less likely to adhere to any follow-up recommenda tion (hazard ratio for no insurance, 0.43 [95%;, confidence interval, 0.20- 0.93], and for clinic, 0.35 [95% confidence interval, 0.15-0.73]). Conclusions: Adherence to follow-up was low in this family planning clinic population, no matter what type of follow-up was advised. Adherence was imp roved by the use of up to 3 reminders. Allocating resources to effective me thods for improving adherence to follow-up of abnormal results may be more important than which follow-up procedure is recommended.