Effect of 2 Interventions on Cervical Cancer Screening Guideline Adherence.

INTRODUCTION: This study sought to determine whether a provider mobile phone application, used with or without a patient educational tool accessed on a computer tablet, would promote adherence to guidelines for cervical cancer screening and management of abnormal cytology in young women. METHODS: The study was conducted as a prospective cohort study in which 14 Family Planning, Access, Care, and Treatment provider clinics were randomized to 1 of 2 arms: (1) provider mobile phone application only or (2) provider mobile phone application plus patient educational tool. The provider mobile phone application gave information to providers regarding cervical cancer screening and management of abnormal cytology. The patient educational tool accessed on a computer tablet was a patient-centered educational tool. Each arm was compared with clinic control groups (no intervention) in a 2:1 ratio (control:intervention). Claims data were used to calculate and compare 18-month cytology (Pap) and colposcopy rates before the intervention and during the 18 months using the Poisson mixed-effect regression model. A sensitivity analysis examined the differences in the rate of change between each arm and controls. The study took place between July 2015 and December 2016, and analysis was performed in 2019. RESULTS: The clinics randomized to the provider mobile phone application plus patient educational tool arm and their control group achieved similar 18-month Pap rates (0.52, 95% CI=0.37, 0.74 and 0.68, 95% CI=0.53, 0.86, respectively) as well as the provider mobile phone application arm and their control group (0.44, 95% CI=0.33, 0.58 and 0.41, 95% CI=0.34, 0.51; p-values >0.1). In the sensitivity analysis, the difference in the rate of change in Pap rates for the provider mobile phone application plus patient educational tool arm and their control group before and during the intervention was -0.22 and -0.09, respectively (p=0.02), but no differences were seen between the provider mobile phone application arm and their control group. No significant changes were observed for colposcopy rates. CONCLUSIONS: Providing clinicians and patients with information on guidelines had no demonstrable effect on 18-month Pap and colposcopy rates in the regression model; however, results from the sensitivity analysis for the patient educational tool were encouraging. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02270021.

Genital herpes education and counselling: testing a one-page 'FAQ' intervention.

Approximately 17% of adults in the USA have antibodies to herpes simplex virus type 2 (HSV-2), 85-90% of whom are unaware of their infection. Diagnosed patients are more likely to detect HSV reactivation, disclose infection status to partner(s) and employ risk-reduction strategies; therefore, diagnosing more cases may reduce herpes transmission rates. Providers are reluctant to identify genital herpes because of potentially lengthy counselling visits or discomfort in dealing with patients' emotional reactions. This study tested the efficacy of a one-page frequently-asked-questions (FAQ) sheet regarding length of initial diagnostic visit, patient satisfaction with topics covered, provider's coverage of topics and resources/referrals provided to patients. Data from 147 patients and 26 providers were analysed. When pre- and post-FAQ sheet data were compared, diagnostic visit time was not substantially reduced but there were favourable trends in patient satisfaction levels on some topics, and providers covered more topics and offered more resources. This FAQ was useful in simplifying topics, providing prompts for providers and resources for patients. While this FAQ sheet appears favourable in this exploratory study, more investigation is needed to measure the degree to which patients use and understand the FAQ sheet, and find it to be a helpful tool.