Presentations

Abstract

Introduction:

Colposcopy is the process of using a colposcope for visualizing and assessing the uterine cervix to identify cervical intraepithelial neoplasia, squamous intraepithelial lesions, or invasive cancer. This procedure is utilized after an abnormal or inconclusive cervical cancer screening test, such as a Papanicolaou (Pap) smear, allowing the clinician to visualize lesions and biopsy to inform future management while minimizing unnecessary excisional procedures. Colposcopies have been implemented at free clinics across the country, preventing loss to follow-up. Currently, the procedure at the HOPES Clinic is to refer patients with abnormal Pap smears with human papillomavirus (HPV) and abnormal cellularity to the Sentara Ambulatory Care Clinic (ACC) for follow-up and colposcopy. Based on current procedures, we have no method of knowing if patients follow up for abnormal results with the ACC, which could potentially pose a serious risk to the patient as colposcopies are a tool in the prevention of cervical cancer.

Methods:

Charts of HOPES Free Clinic patients that were seen for Pap smears and referred to ACC for colposcopy were evaluated in Practice Fusion to record patient demographics. Patients who required referral for colposcopy follow-up were reviewed in Epic in addition to Practice Fusion to record the date their Pap smear came back as abnormal from HOPES Free Clinic and collect the date they were seen at Sentara's ACC, if applicable. Pap smear cytology results as well as colposcopy and biopsy procedure results were recorded. Finally, the patient's follow-up recommendations were recorded, including loop electrosurgical excision procedure, repeat colposcopy, treatment for cervical cancer, or follow-up within one year.

Results:

Between January 2017 and June 2022, there were eight patients who had recorded referrals from HOPES Free Clinic to ACC for colposcopy follow-up after receiving abnormal and/or inconclusive Pap smear results. Of these 8 patients, only 4 patients (50%) had recorded follow-up appointments at the ACC for colposcopy procedures.

Conclusions:

While our data is limited due to the nature of recording referrals from HOPES Free Clinic to the ACC, the rate of completed follow-up at ACC for colposcopies indicates there is a loss to follow- up in patients with abnormal Pap smears. This is significant in identifying a gap in patient healthcare continuity that exists at HOPES Free Clinic through the current procedures for abnormal Pap smear results, indicating follow-up at HOPES Free Clinic rather than external referral could improve outcome tracking systems through improved communication avenues with patients. In referring patients out to the ACC for colposcopy follow-up, HOPES Free Clinic is unable to track completed follow-up on abnormal results, potentially limiting the clinic's ability to prevent the progression of cervical cancer in the vulnerable patient population. As such, there is some evidence for an improved communication system regarding completed follow-up between the HOPES Free Clinic and ACC to facilitate continuity of care for patients with abnormal Pap smear results. Additionally, future research and quality improvement studies could center around obtaining more information about follow-up barriers to patients who are referred to the ACC.