DECREASING UNNECESSARY PAP TESTS AND COLPOSCOPIES UTILIZING 2012 ASCCP GUIDELINES
Background: Currently, in the United States, despite clear cervical cancer screening guidelines, it is reported that 58% of women over the age of 65 have had a Pap test in the past 3 years and 34% of women with a hysterectomy report a Pap test within the past 1 year. Additionally, 57% of adolescents age 18-21 were still receiving Pap testing as of 2011. Women are continuing to have annual Pap testing regardless of negative HPV status, partly because 31% of providers are still recommending annual testing to their patients. This over screening can result in an increase in false positive results, leading to rising healthcare costs, additional office visits, and psychological stress to the patient with annual exams or incorrect procedures that yield little useful information or decrease in morbidity. Although consensus guidelines and algorithms detailing screening guidelines, management and follow up recommendations have been published by the ASCCP, providers are still performing unnecessary colposcopies, biopsies, and repeat Pap tests prior to recommended follow up.
Methods: This project will utilize the Catalyst Model by Brown & Ecoff, also referred to as the Evidence Based Practice Institute Model. According to this model, after identifying the catalyst and describing why the problem is important, we develop a PICO question, search the literature for evidence, and appraise the evidence to determine if there is enough to support a practice change. Problem assessment in the setting will be done by identifying unnecessary procedures by comparing management of abnormal PAP results over 3 month period to the 2012 ASCCP guideline recommendations. Next, provider’s knowledge and comfort level with guidelines will be assessed using a survey on the frequency of screening, use of co-testing with HPV, and management of abnormal cytology results. Once this data is obtained, the data will be applied by outlining the practice to be changed, identifying desired outcomes, and implementing change into practice through provider education. Educational sessions will be developed and conducted using multiple tools to help providers apply the algorithms for abnormal cytology algorithms including a web-based tool, mobile app, and simplified one-page algorithm.
Outcomes Achieved: A second chart review will be conducted 3 months after the intervention in the same manner to identify the number of inappropriate management of PAP results according to the ASCCP guidelines.
Conclusions: If successful, implementation will increase provider comfort level and knowledge of the guidelines, which will in turn lead to decreased numbers of appointments and follow-up procedures, therefore a decrease in cost to the clinic. It may also increase patient satisfaction by decreasing unnecessary patient anxiety.