The effect of the family physician on improving follow-up after an abnormal PAP smear.

OBJECTIVE: The aim of this study was to assess the effect of the family physician on improving compliance with follow-up of abnormal smears in cervical cancer screening. DESIGN: Observational study. SETTING: Two Regional Health Authority districts in the east of The Netherlands. STUDY PARTICIPANTS: Family practices with a national call system for cervical cancer screening and family practices with a family-practice-based call system. In a number of practices the family physicians had introduced a fail-safe system for follow-up. MAIN OUTCOME MEASURES: Follow-up of women who participated in the first screening round and in whom a cytological abnormality had been diagnosed in the first smear. Criteria for adequate follow-up were defined with regard to the severity of the cytological abnormality. RESULTS: The overall compliance with follow-up in the study-group was 88%. The study showed a strong relationship between involvement of the family physician and compliance with follow-up. The compliance in practices that had a fail-safe system for follow-up was 93% compared to 82% in the practices without a fail-safe system. The highest follow-up was found in practices involved in the family-practice-based system.

General practitioner based screening for cervical cancer: higher participation of women with a higher risk?

OBJECTIVE: To test the hypothesis that a personal invitation for cervical screening by a woman's own general practitioner (GP) achieves a higher attendance of women with an increased risk for cervical cancer. SETTING: Two general practices and the local health authority screening programme for cervical cancer, Nijmegen, The Netherlands. METHODS: Attendance rates of women with an increased risk of cervical cancer were compared for two invitation strategies: (a) invitation by the woman's own GP, and (b) invitation by a national call system through the local health authority. Data on risk profiles were gathered by questionnaire. Two hundred and thirty eight women eligible for screening were invited by their GPs (GP group), and 235 women by the local health authority (control group) in 1992. RESULTS: The personal invitation by the GP resulted in an 18% higher overall attendance, and a 28% higher attendance of women with greater risk because of sexual behaviour and smoking. CONCLUSION: Greater involvement of the GP in inviting women for cervical cancer screening results in a higher attendance, particularly among women with increased risk, than a less personal health authority call system.

Cellular composition of cervical smears taken by general practitioners.

The quality of the cervical smears taken by general practitioners, and also by some practice assistants, of the Dutch Screening Programme in the region of Nijmegen was evaluated. Of 18,398 preventive cervical smears taken by GPs in this region, 437 (2%) were diagnosed as "class" 0 and 2907 (16%) smears did not contain endocervical cells (EC-). The quality of the smears per general practitioner varied enormously. The percentage of smears without endocervical cells taken by six practice assistants was 18. During the screening period the percentage of smears without endocervical cells taken by GPs decreased from 19 (1989) to 14 (1992). In February 1990 the six practice assistants followed a theoretical and practical course on cervical smear-taking. Remarkable was the decrease in the percentage of smears without an endocervical component from 25% in 1990 to 13% in 1991. The quality of smears taken by GPs would improve if the general practitioner had more experience in smear-taking. We recommend to offer GPs the opportunity to take practical training courses in smear-taking, just as the practice assistants in this project.

Preliminary results of a general practice based call system for cervical cancer screening in The Netherlands.

A study was undertaken in Nijmegen, in the Netherlands, to compare the attendance rate following a call system for cervical cancer screening organized by general practitioners, with the attendance rate resulting from the Dutch national call system. Women are invited for screening on a three yearly basis and in 1990 1616 women were identified by nine practices as being in the appropriate age group (35 to 54 years) to attend for cervical cancer screening while 10,387 women were identified by the national call system. The attendance rate among the 1101 women in the rural general practices was 58%, compared with 49% of 4154 women in the matched group receiving an invitation from the national call system. The attendance rate among the 515 women in the urban general practices was 55%, compared with 41% of 6233 women in the matched group receiving an invitation from the national call system. Invitations from general practitioners resulted in similar percentages of women in all age groups attending for screening. Four general practices sent a reminder letter or made a telephone call to non-attenders. A reminder increased the attendance rate from 58% to 70%. It is concluded that a general practice based call system for cervical screening produces a higher attendance rate than the national call system.

Implementation of the national cervical cancer screening in general practice and feasibility of a general practice-based call system: the GP's opinion.

Thus far, the response to the nationwide screening programme for cervical cancer in The Netherlands, which was started in 1989, has been disappointing. One way to improve response is to involve general practitioners in the call system. A postal survey was conducted to review the implementation of the current screening programme in general practice and to examine the willingness of general practitioners to participate in a general practice-based call system. The response rate to the survey was 90%. The general practitioners were dissatisfied with follow-up, cost and time spent and compliance of women. Of all respondents 60% had already set up a call system within the practice or were willing to do so; another 31% were willing to participate in a regionally organized practice-based call system. On the basis of the results of this study a centralized general practice-based call system is recommended. The next step is to study the applicability of this system in a pilot programme.

[14 years of screening for cervix carcinoma in a family practice]. / Veertien jaar screening op cervixcarcinoom in een huisartspraktijk.

Since 1975 the general practitioners of 'Ons Medies Centrum' in Oss have been inviting women systematically for cervical screening and cervical smears. The attendance and protection rate were evaluated for the period 1975-1989. 85% of the women 35-54 years of age had had a cervical smear within 5 years after they entered the general practice or had not been invited because of a total hysterectomy. After a starting period of a few years the protection rate stabilised at 75%. There was no relation between residential quarter, health insurance, ethnic origin and attendance for the screening. Age was the only factor related to attendance: the attendance rate among older women was lower.