Patient and provider characteristics associated with inadequate cervical cancer screening in a community health center Free

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RESEARCH QUESTION: Are there significant differences between female patients who are adequately or inadequately screened for cervical cancer at the same community health center?
 Patient characteristics: patient demographics, patient health behavior, chronic disease diagnoses.
 Provider characteristics: primary care provider demographics, primary care provider gynecological exam referral patterns.
 HYPOTHESIS: Significant differences in certain patient factors (e.g. chronic disease diagnoses) and certain physician factors (e.g. not perfoming Pap testing) will be associated with inadequate cervical cancer screening.
 METHODS: We designed a retrospective cohort study including all of the female patients at a community health center who were eligible for cervical cancer screening between the years 2001-2005. We identified 3878 eligible patients and included 3870 patients in our analyses.
 Bivariate analyses examined the patient and provider characteristics associated with our binary dependent variable, whether or not a Pap smear was performed within 3 years. We then built a logistic multivariable regression model to identify independent predictors.
 RESULTS: Overall, 80% (n=3105) of eligible patients received Pap testing within three years. Patient characteristics that were significantly (p <.05) associated with not receiving Pap testing were: older age (X² = 42.1 yrs vs. X² = 37.8 yrs), greater number of months since last center visit (X² = 16.7 months and X² = 7.3 months), and the lower number of total center visits (X² = 7.8 visits vs. X² = 10.4 visits). Patient characteristics that were not significantly associated with Pap testing included: type of insurance, race/ethnicity, body mass index, measured cervical cancer risk factors, or chronic disease diagnosis. None of the measured provider characteristics, including provider referral for Pap testing and provider demographics such as gender and ethnicity, were significantly associated with our outcome.
 All of the variables entered into the final regression model remained significant. The greater the number of months since their last visit (p = .003) and the lower the number of total center visits (p <.0001), the less likely a patient was to have received Pap testing. When compared to the youngest group, female patients aged 25-29.9 years old were significantly more likely to receive Pap testing (OR= 1.046; p <.0001). However, female patients aged 30-47.9 years old were significantly less likely to receive Pap testing (OR= 0.773; p = 0.03) as were female patients aged 48 years old or older (OR = 0.491; p <.0001).
 CONCLUSIONS: Older age was the most significant predictor associated with not receiving a Pap test in this population. In addition, patients were less likely to receive Pap testing the greater the amount of time since their last visit and if they had a fewer number of total visits. None of the measured provider characteristics were associated with whether or not Pap testing was performed. These findings are likely generalizable to other community health centers and have substantial implications regarding interventions that target the most vulnerable patients within the population.