BMJ 1994;308:1272-1276 (14 May)

General practice

Using patient and general practice characteristics to explain variations in cervical smear uptake rates

F A Majeed, D G Cook, H R Anderson, S Hilton, S Bunn, C Stones 

Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE Department of General Practice, St George's Hospital Medical School, London SW17 0RE Merton, Sutton, and Wandsworth Family Health Services Authority, London SW15 2SW Correspondence to: Dr Majeed.

Abstract

Objectives : To produce practice and patient20variables for general practices from census and family health services authority data, and to determine the importance of these variables in explaining variation in cervical smear uptake rates between practices.
Design : Population based study examining variations in cervical smear uptake rates among 126 general practices using routine data.
Setting : Merton, Sutton, and Wandsworth Family Health Services Authority, which covers parts of inner and outer London.
Main outcome measure : Percentage of women aged 25-64 years registered with a general practitioner who had undergone a cervical smear test during the five and a half years preceding 31 March 1992.
Results : Cervical smear uptake rates varied from 16.5% to 94.1%. The estimated percentage of practice population from ethnic minority groups correlated negatively with uptake rates (r=-0.42), as did variables associated with social deprivation such as overcrowding (r=-0.42), not owning a car (r=-0.41), and unemployment (r=-0.40). Percentage of practice population under 5 years of age correlated positively with uptake rate (r=0.42). Rates were higher in practices with a female partner than in those without (66.6% v 49.1%; difference 17.5% (95% confidence interval 10.5% to 24.5%)), and in computerised than in non- computerised practices (64.5% v 50.5%; 14.0% (6.4% to 21.6%)). Rates were higher in larger practices. In a stepwise multiple regression model that explained 52% of variation, five factors wre significant predictors of uptake rates: presence of a female partner; children under 5; overcrowding; number of women aged 35-44 as percentage of all women aged 25-64; change of address in past year.
Conclusions : Over half of variation in cervical smear uptake rates can be explained by patient and practice variables derived from census and family health services authority data; these variables may have a role in explaining variations in performance of general practices and in producing adjusted measures of practice performance. Practices with a female partner had substantially higher uptake rates.

Public health implications

  • Public health implications

  • The performance of general practices varies widely - for example, in the cervical smear uptake rates they achieve

  • Advances in information technology combined with the availability of data from the 1991 census allow the production of a range of sociodemographic variables for general practice

  • These sociodemographic variables, when used in a multiple regression model with practice variables, explained over half the variation in cervical smear uptake rates among the general practices in Merton, Sutton, and Wandsworth Family Health Services Authority

  • Practices with a female partner had substantially higher uptake rates even after other factors were adjusted for, suggesting that appointing a female partner may help raise a practice's cervical smear uptake rate

  • Practices' sociodemographic variables may also have a role in planning primary care services and in allocating resources to general practices


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