Abstract
BackgroundIn France, with the growing scarcity of gynecologists and a globally low and socially differentiated coverage of cervical cancer screening (CCS), general practitioners (GPs) are valuable resources to improve screening services for women. Still all GPs do not perform Pap smears. In order to promote this screening among GPs, the characteristics of physicians who never perform CCS should be more precisely specified. Besides already-known individual characteristics, the contextual aspects of the physicians’ office, such as gynecologist density in the area, could shape GPs gynecological activities.MethodsTo analyze county (département) characteristics of GPs’ office associated with no performance of CCS, we used a representative sample of 1063 French GPs conducted in 2009 and we constructed mixed models with two levels, GP and county.ResultsAlmost 35% (n = 369) of the GPs declared never performing CCS. GPs working in counties with a poor GP-density per inhabitants were more likely to perform CCS (odds ratio (OR) = 0.52 for each increase of density by 1 GP per 10,000 inhabitants, 95% confidence interval (CI) = 0.37–0.74). On the contrary, GPs working in counties with an easier access to a gynecologist were more likely not to perform CCS (OR = 1.06 for each increase of density by 1 gynecologist per 100,000 women, 95%CI = 1.03–1.10 and OR = 2.02 if the first gynecologist is reachable in less than 15 min, 95%CI = 1.20–3.41) as well as GPs working in areas with a poverty rate above the national average (OR = 1.66, 95%CI = 1.09–2.54). These contextual characteristics explain most of the differences between counties concerning rates of not performing CCS.ConclusionsSpecific programs should be developed for GPs working in contexts unfavorable to their involvement in CCS.
Highlights
In France, with the growing scarcity of gynecologists and a globally low and socially differentiated coverage of cervical cancer screening (CCS), general practitioners (GPs) are valuable resources to improve screening services for women
GPs working in a county with high poverty indicators were more likely not to perform CCS: GPs declared never performing Pap smear all the more frequently that they worked in a county with higher poverty gap index
Health care availability and access characteristics were associated with no performance of CCS: GPs declared never performing Pap smear all the more frequently that they worked in a county with higher gynaecologist density
Summary
In France, with the growing scarcity of gynecologists and a globally low and socially differentiated coverage of cervical cancer screening (CCS), general practitioners (GPs) are valuable resources to improve screening services for women. In France there was no nationwide organized screening program for cervical cancer screening (CCS) before 2019 but few programs involving ambulatory care and organized at the county (département) level GPs are in regular contact with the entire population, contrary to specialists, to whom the lower levels of the social hierarchy have limited access [11]. They are in a favourable position to offer Pap smear to underprivileged women never or rarely screened and who present the majority of
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