Compliance With Cervical Health Recommendations in the Inflammatory Bowel Disease Population: The Effect of a Formal Health Maintenance Program

Abstract

Introduction: Human papilloma virus (HPV) is the most common sexually transmitted infection in the United States and can lead to cervical cancer. Cervical cancer risk is increased among women with inflammatory bowel disease (IBD) particularly those on immunosuppressive medications. Preventive measures include HPV vaccination in young women, and an annual pap smear. We aim to evaluate the effectiveness of a health maintenance program (HMP) started in December 2011 aimed at improving compliance with these recommendations. Prior to that date, recommendations for cervical health were made at the discretion of the treating gastroenterologist. The HMP includes a check list of health maintenance measures reviewed with the patient at the time of the office visit, and shared with the primary care physician and gynecologist. It also includes reminder letters sent a few months following the office visit. Methods: This is a retrospective study looking at the cervical health care of female IBD patients seen between 2005 and 2014 at our institution, before and after the implementation of the HMP. Out of 740 patients seen, we randomly selected to review the data on 114 patients. Results: The patients’ age ranged from 20-86 years old with a median age of 33. Of the 114, 68 patients were seen both before and after the implementation of the HMP. Of these 68 patients, only 9 (13%) had the HPV vaccine before the HMP compared to 16 (23.5%) after the HMP (p=0.13). Of the 8 patients younger than 26 years of age, 2 had the HPV vaccine before, and 2 had the HPV vaccine after the HMP. There was no difference in pap smears rate (85%) in patients seen before and after HMP. A total of 46 patients were seen only after the implementation of HMP. Nine (20%) of these patients had the HPV vaccine. Of the 12 patients younger than 26 years of age, only 2 had the HPV vaccine. Of all the 114 patients seen after the implementation of the HMP, 87 patients (76%) had a pap smear, and 25 patients (22%) had the HPV vaccine. No patient developed cervical cancer. Conclusion: Our data shows that most women with IBD follow pap smear recommendations even when only mentioned at the office visit. However, despite the implementation of HMP, less than a quarter of young women proceed with HPV vaccination. Reasons for this poor compliance are unclear but could be due to reluctance to receive this vaccine out of fear of side effect or for personal/religious reasons. More effort should focus on educating patients about HPV associated diseases and partnering with the treating gynecologists to promote cervical health.