Predictors of compliance in colposcopy clinic follow-up among the uninsured

Abstract

e20511 Background: Despite successful screening programs for cervical cancer, ethnic disparities persist. The no-show rate for follow-up appointments after HPV-related abnormal pap smears approximates 50% in high risk populations. We sought to identify factors that may influence follow-up compliance in a multi-ethnic, low income population at risk for cervical cancer. Methods: A longitudinal cohort study was conducted by chart review for all patients identified as having had a colposcopy exam for HPV-associated cervical dysplasia at a southern California inner city clinic from 2006 to 2007. Compliance was defined as obtaining a pap smear within 3 to 14 months from the initial colposcopy. The following variables were evaluated in a multivariate logistic regression model to identify factors which predicted follow-up compliance: race, age, preferred language, insurance, income, marital status, cytology, histology, history of a LLETZ, and pregnancy status. Results: During the study period, 438 patients attended the colposcopy clinic. This approximates 52% of the 912 scheduled clinic appointments during 2006. Patients’ median age was 28 years, 41% were Spanish speaking, with an estimated median income of less than $20,000 for half of the sample. Approximately 71% of patients had temporary publically-funded insurance. Only 55% (239/438) returned for recommended follow-up pap smear. In univariate and multivariate analysis, neither language, Spanish surname, median income, age, histology, nor insurance status predicted adequate follow-up (p=ns). A history of having undergone a large loop excision of the transformation zone (LLETZ) was the only factor which significantly predicted compliance with recommended follow-up pap smear (OR=1.76; 95% CI 1.08–2.895). Conclusions: Follow-up compliance for this high-risk, low income population is very poor. Identifying factors which predict noncompliance could inform strategies to improve care. In this analysis a history of LLETZ was the only variable which predicted whether follow-up care occurred as recommended. Results suggest that intensive, culturally-sensitive colposcopy clinic-based educational interventions should be developed and evaluated. No significant financial relationships to disclose.