Audit of practice based cervical smear programme: completion of the cycle.

Abstract

OBJECTIVES--To determine the effectiveness of a practice based cervical screening programme and the changing pattern of abnormal smear results and to improve the quality of care provided for patients. DESIGN--Audit of practice held data on cervical screening from 1980 to 1990. Changes in the programme were made after analysis of first five years' data. SETTING--Mixed urban and rural practice of 10,900 patients in Northumberland. SUBJECTS--Women aged 20-65 who had not had a hysterectomy. RESULTS--2356 (85.1%) of the 2767 targeted women had a test during 1980-5 and 2498 (89.5%) of the 2790 women had a test during 1985-90. Inviting women aged 20-25 to attend for a test increased coverage from 45.8% (146/319) in 1980-5 to 82.5% (282/342) in 1985-90. The proportion of women with abnormalities requiring hospital referral rose in the second half of the study, especially among younger women (from 17/39 (44%) to 45/64 (70%) in women aged 25-34). CONCLUSIONS--Practice based cervical screening programmes can be highly effective. Cytological abnormalities affect patients psychologically as well as physically and practices should provide support and explanation for patients with abnormal results. Data from individual practices should be aggregated to allow health authorities to plan secondary care effectively.