How Effectively Do Health Care Providers Adhere To Established Clinical Guidelines Concerning Breast and Cervical Screening as Outlined by the American Cancer Society and the American College of Obstetrics and Gynecology?
Abstract
**Please note that the full text is embargoed** ABSTRACT: Purpose: To investigate how effectively health care providers in a rural health clinic setting
adhere to established clinical practice guidelines (CPGs) concerning breast and cervical
screenings as outlined by the American Cancer Society (ACS) and the American College of
Obstetrics and Gynecology (ACOG).
2
Methodology: A retrospective chart review of 226 randomly selected medical records of
females aged 21 years to 69 years of age during the six month period from April 1, 2011 through
September 30, 2011 was performed. Charts were reviewed using an investigator developed
medical records review tool for date of last preventive screening, currency of screening, a
recommendation for screening, and documentation of a reason for the lack of screening.
Additionally, clinic providers were administered a questionnaire to examine their attitudes and
beliefs concerning CPGs as well as their perceptions regarding barriers to preventive screenings
among rural women.
Findings: n = 226. The findings from this retrospective record review reflected that 51.4% of
subjects were not current in their mammography screening and 46 % were not current in cervical
screenings. Fifty-five subjects who were not current in mammography screening had no
documentation of a recommendation for screening. Of the 104 subjects who were not current
with their Pap testing, only fourteen (6.2%) received a recommendation for screening. A second
purpose of this clinical project was to survey health care providers concerning their views
regarding CPGs and perceived barriers in breast and cervical screenings. Results from a health
provider questionnaire found the provider participants having mixed feelings concerning
preventive screening barriers. Providers agreed that time constraints (66.6%) during routine
visits was a factor, while 48% agreed that guideline confusion was an issue. All providers were
in agreement that reimbursement was not an influencing factor. Sixty-four percent of providers
indicated that patient compliance influenced CPG non-adherence.
3
Implications for practice: Previous research supports that a recommendation from a health
care provider is associated with adherence to preventive services for women. Findings from this
clinical project indicated that in this particular sample (n = 226), a low percentage of rural
women who were not current in their breast (51.4%) and cervical (46 %) screenings, had
documentation of having received a recommendation by a health care provider for a preventive
screening. Findings also pointed out the need for clearer CPGs, clearer protocols for making
recommendations, clearer documentation formats in the medical record, surveillance and
monitoring of recommendations and preventive screening compliance, and education of
providers and clients concerning changing CPGs. Community and state programs targeted to
educate rural females concerning preventive services as well as grants/money to provide low cost
breast and cervical screenings may help to increase compliance. Additionally, the findings
indicate that there is a need for more education for health care providers concerning preventive
maintenance services and the need to allocate more time for preventive care visits. Reducing
morbidity and mortality related to both cancers improves the quality of life with early detection.
Early initiation of treatment leads to a better prognosis.