Pap Smear Follow-up At the Phoenix Indian Medical Center

The objective of this study was to determine the disposition of women having abnormal Pap tests at the Phoenix Indian Medical Center and to identify reasons some women who have abnormal Pap tests are lost to follow-up. This was a descriptive study utilizing patient records to identify women who had abnormal Pap tests in 2002 and the status of their follow-up care. Women who had no clinical record of follow-up were contacted by telephone to arrange a follow-up appointment and request participation in a structured qualitative interview to identify barriers to follow-up at the individual, family, community, and health care system levels. Two thirds of women with no record of follow-up were located by telephone 2-3 years after the abnormal Pap test finding. While record review resulted in a loss-to-follow-up rate of 23.3%, aggressive tracking of patients with no record of follow-up decreased the loss rate to 11.1%. The same proportion (11.1%) of women received follow-up care within the recommended time-frame, leaving 77.8% receiving follow-up, but not in accordance with clinical practice guidelines. Most of the barriers to follow-up appear to reside within challenges of the health care system in communicating the need for follow up and in providing access to care within a timeframe appropriate for clinical care. Conclusion: While these findings place an important additional responsibility and burden on the health care system serving American Indian women, our research outreach efforts suggest that given the availability of appropriate resources, these barriers can be overcome.