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COLPOSCOPY Improving Patient Adherence and Understanding
Tiffany T. Peters, MD CPT, MC USA Martin Army Family Medicine Residency Program Fort Benning, GA
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Colposcopy in Family Medicine
Colposcopy is an important tool in cervical cancer screening Over 2 million women annually will undergo colposcopy Despite a historical decline in morbidity and mortality, cervical cancer remains a leading cause of death in women worldwide Partially due to patient non-adherence with recommendations for follow up
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Patient non-adherence rates range from 10-60%
Non-adherence rate at Martin Army Hospital approximately 40% Performance Improvement Project Examine factors that contribute to non-adherence Identify specific problems and develop a comprehensive approach to improving adherence
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Patient Non-Adherence
Several factors contribute to non-adherence Patient’s lack of knowledge Forgetfulness Onset of menses Anxiety/fear of procedure Unplanned event Logistical difficulties (work, child care, transportation, etc) Access to medical care
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Special Circumstances
Military Facility Advantages Easy access to care, procedure at one hospital, EMR Disadvantages Relocation of patients and providers Residency Program Assist in resident education Patient may be uncomfortable with resident provider Turn around of resident providers
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Colposcopy Clinic at Martin Army Community Hospital
Patient receives results of abnormal pap smear Consult placed, letter and appointment generated and mailed to patient Information on colposcopy is included with letter Patient arrives at scheduled time for 1 hour appointment Results received via mail or telephone
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Problems Identified High no-show rate
No pregnancy test done prior to appointment (clinic requirement) Time spent counseling prior to procedure Nonconformity regarding documentation procedures Lost to follow up
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Colposcopy Clinic Project
Patient notified of abnormal pap smear Consult placed, letter and appointments generated Pre-counseling appointment Procedure appointment Follow up appointment (modeled after procedures in place for vasectomies) Pt watches video from NIH Physician then addresses questions/concerns Consent forms reviewed and signed Pregnancy test ordered/performed
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Procedure appointment
Scheduled the day after pre-counseling Establishment of unified documentation system utilizing EMR Follow up appointment Scheduled 4 weeks after procedure appointment with same provider performing colposcopy Extended follow up—pt’s contacted by clinic about 1 month prior to appointment as reminder to schedule Patient remains in colposcopy clinic until resumes routine annual exams
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Summary Goals of Colposcopy Project
Improve patient compliance with follow up Increase patient knowledge of disease and screening processes Decrease anxiety/fear Improve scheduling to attempt to avoid procedure during menses Improve tracking of abnormal pap with unified documentation system Enhance resident education/provide continuity of care
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Represents ONE way to address issues….
Additional ideas include Educational programs Pre-counseling sessions (individual, group, telephone) Reminder systems (telephone, letter, certified letter) Transportation assistance
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