Cervical cancer screening in the urgent care setting

OBJECTIVE: To determine the feasibility of cervical cancer screening in an urgent care clinic. DESIGN: Prospective randomized trial. SETTING: Public teaching hospital. PATIENTS: Women presenting to the urgent care clinic whose evaluation neces sitated a pelvic examination were eligible for participation. Women who had a hysterectomy, had a documented Pap test at our institution in the past y ear, did not speak English or Spanish, or had significant vaginal bleeding were excluded. Women presenting to the gynecology clinic for a scheduled Pa p test were used as a comparison group for rates of follow-up, Pap smear ad equacy, and Pap smear abnormalities. INTERVENTIONS: Women randomized to the intervention group had a Pap test pe rformed as part of their pelvic examination, while women in the usual care group were encouraged to schedule an appointment in the gynecology clinic a t a later date. The women in the two groups completed identical questionnai res regarding cervical cancer risk factors and demographic information. MEASUREMENTS AND MAIN RESULTS: Ninety-four (84.7%) of 111 women in the inte rvention group received a Pap test, as compared with 25 (29%) of 86 in the usual care group (P < .01). However, only 5 (24%) of 21 women with abnormal Pap smears in the intervention group received follow-up compared with 6 (6 0%) of 10 women seen during the same time period in the gynecology clinic f or self-referred, routine annual examinations (P = .11). Pap smears obtaine d in the urgent care clinic were similar to those in the gynecology clinic with regard to abnormality rate (22.3% vs 20%; P = .75, respectively) and s pecimen adequacy (67% vs 72%; P = .54, respectively). CONCLUSIONS: Urgent care clinic visits can be used as opportunities to perf orm Pap test screening in women who are unlikely to adhere to cervical canc er screening recommendations. However, to accrue the full potential benefit from this intervention, an improved process to ensure patient follow-up mu st be developed.