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.