Barriers to follow-up of abnormal Papanicolaou smears in an urban community health center.

OBJECTIVE: To determine factors predictive of failure to return for colposcopy among women with significant abnormalities on Papanicolaou smears in a high-risk clinical population. DESIGN: Telephone survey. SETTING: An urban community health center. PARTICIPANTS: Two hundred seventy-nine women randomly selected from all women seen at the health center with abnormal Papanicolaou smears requiring colposcopy during 1993 to 1994. Six (2%) refused participation, and 19% could not be reached for inclusion. Subjects were mostly minority women receiving Medicaid. MAIN OUTCOME MEASURE: Completion of colposcopy. RESULTS: Of the 279 selected women, 79% were interviewed. The rate of adherence with colposcopy was 75% for the respondents. Women who did not know the results of their smear or who incorrectly understood their results were significantly less likely to return for colposcopy (P = .001). Younger women, especially teenagers, were less likely to return (P = .02). Socioeconomic status, education, primary language, health beliefs, fear of cancer, and clinician's gender or discipline were not associated with rate of follow-up. Barriers involving transportation, child care, and insurance also did not predict follow-up. CONCLUSIONS: Effective communication of results is the most important factor related to follow-up after abnormal Papanicolaou smear in this setting. In other settings, other factors may be of greater importance.

Intestinal parasites in Cambodians: comparison of diagnostic methods used in screening refugees with implications for treatment of populations with high rates of infestation.

We performed a retrospective review of screening parasitology examinations on a Cambodian refugee population served by an urban neighborhood health center. Five-hundred twenty of 1084 patients were examined for ova and parasites either by purged stool, which was examined immediately, or preserved stool, examined at a teaching hospital and proprietary laboratories. Overall, 335 (64 percent) of the tested patients had at least one parasite. The prevalence of infection varied by test technique (purged stool examined immediately, 86 percent; preserved stool examined at a hospital, 65 percent; preserved stool sent to a proprietary laboratory, 31 percent, P less than 0.01). In this population where Entamoeba histolytica infection was 44 percent as measured by the purged warm stool technique, the cold preserved stool test had a measured relative sensitivity of 33 percent. Assuming a selectivity of 99 percent, it would take eight negative tests to reach a greater than 95 percent negative predictive value. The high rate of intestinal carriage of pathogenic parasites in this population and the insensitivity of commonly available diagnostic tests make routine presumptive treatment of intestinal parasites an option when the purged stool examination is unavailable.