Utilization of Cervical Testing Among Women with Inflammatory Bowel Disease

Abstract

Purpose: Women with inflammatory bowel disease (IBD) have a higher incidence of abnormal Pap smear compared to women without IBD. However, the actual rate of cervical testing among women with IBD is unknown. We aimed to determine cervical testing rates among a large sample of women with IBD and specifically among women with IBD on immunosuppressant medications. We also aimed to identify specific risk factors associated with poor cervical testing rates among women with IBD in order to target future quality improvement initiatives. Methods: We extracted medical and pharmacy claims from the PharMetrics Patient-Centric Database, containing data from 87 health plans in 33 states spanning the period January 2003-December 2005. We identified cases of CD and UC with claims for at least 3 IBD-associated visits or at least 1 visit and 1 IBD-specific prescription. For each case, we randomly selected up to 3 non-IBD controls, matched for age, health plan, and geographic region. Using logistic regression, we compared utilization of cervical testing (identified by a validated claims algorithm) by IBD case status, age, immunosuppressive medication use, Medicaid insurance status (a proxy for socioeconomic status) and whether a primary care physician (PCP) was seen. Results: Only 70.4% of women with IBD (N = 9356) and 65.2% of their non-IBD matched controls (N = 25849) received recommended cervical testing (at least once every three years). Women with IBD who had a primary care visit had improved odds of cervical testing (OR 1.37 95% CI 1.19–1.59). Factors associated with reduced cervical testing included Medicaid insurance (OR 0.28, 95% CI 0.19–0.41), immunosuppressant medication use (OR 0.81, 95% CI 0.74–0.88) and increasing age (OR 0.77; 95% CI 0.74–0.81 for each 10 year increase in age). When only women with IBD on immunosuppressive medications were evaluated (N = 7415), only 51.0% obtained cervical testing within a 15 month period (to approximate the recommended 12 month interval for immunosuppressed women). Those with a PCP had improved odds of cervical testing (OR 1.28, 95% CI 1.14–1.45). Those with Medicaid insurance had reduced odds of cervical testing (OR 0.54, 95% CI 0.39–0.74). Conclusion: Women with IBD, especially those with Medicaid insurance, have suboptimal cervical testing rates. Women with IBD who had at least 1 visit to a primary care physician had improved rates of recommended cervical testing. Quality improvement initiatives are needed in order to improve preventive services, including cervical testing, for women with IBD.