Cervical cancer screening: at the patient's or the health system's convenience?

This study examined procedures for providing cervical cancer screening for American Indian women on a large southwestern reservation. A health facility on the reservation investigated the consequences of changing the focal point of cervical cancer screening. The facility abolished its women's clinic, and designated a female health care provider to be available in an afternoon walk-in clinic. The clinic later added similar services to the weekly morning diabetes clinic. Researchers evaluated the consequences of these changes in several ways. They calculated the average monthly volume of Papanicolaou (Pap) tests, for 1 study site and 2 control sites, for each of the 6 months before and after April 1, 1990. Results indicate that neither the total number of Pap smears performed nor the number or abnormal Pap smears detected at the study site before and after the clinic reorganization changed in a statistically significant way. However, average monthly volume of the tests improved (based on 6 months of data). After the clinic change, a trend appeared showing increasing numbers of Pap smears performed on older women, and on women who did not have a Pap smear in the previous year. Results suggest that clinics should offer screening services at the patient's convenience, often on a walk-in basis.