Attendance to cervical cancer screening in family practices in the Netherlands

Background. The effectiveness of three different organizational approaches to cervical cancer screening (community based, family practice based, and a combination) was evaluated in nationally representative family practices. Method. We selected 122 family practices with a computerized sex-age regist er from a database of 1,251 family practices, representative of all 4,758 f amily practices in The Netherlands. Approximately 40 practices were linked with each approach. We measured the attendance, the reasons for nonattendan ce, and the influence of a reminder on the attendance of women invited for cervical screening in September, October, and November 1996. The patients w ere grouped according to age, A cross-sectional design was used for the stu dy. Results. For younger women, the total attendance rate, coverage (percentage of women "protected" against cervical cancer), and control rate (percentag e of women with medical reasons for nonattendance or postponement of the sm ear) were highest in practices using the family practice-based approach (68 , 77, and 90%, respectively) and lowest in practices with the community-bas ed approach (53, 62, and 68%, respectively). For older women, the family pr actice-based approach and the combination approach were associated with att endance rates significantly higher than those for the community-based appro ach (approximately 60, 80, and 80% vs 47, 67, and 70%, respectively). A rem inder sent by the family physician to women not responding to an initial in vitation increased the attendance rate by 7 to 11% in both age categories, depending on who had sent the first invitation. Conclusion. A family practice-based cervical screening approach appeared to be the most effective at a national level, achieving the highest attendanc e rate, coverage, and control rate. (C) 2000 American Health Foundation and Academic Press.