ELIMINATING PELVIC EXAMINATIONS AND PAP SCREENING FOR ADOLESCENTS INITIATING CONTRACEPTION

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Abstract

Purpose: To decrease unnecessary Pap screenings in adolescents while increasing access to contraception, thereby decreasing unintended pregnancies without increasing cervical cancer risk. To implement and evaluate a multifaceted educational program for health care providers (HCP) and office staff to determine level of adherence to recommendations for Pap screening and prescribing hormonal contraception, examining obstacles preventing adherence to current practice recommendations. Background: The United States has 1 of the highest rates of unintended pregnancies in the world among industrialized nations. Adolescents often avoid contraception initiation fearing Pap screening and pelvic examinations. Adolescents may initiate contraception earlier if not required to undergo these examinations. Methods: Complete data were collected on 192 adolescent records, pre-intervention (n = 95), post-intervention (n = 97), to determine if a practice change occurred after a multifaceted education program. Adolescents were aged 15 to 21 years. Pre- and post-intervention surveys were conducted to assess attitudes and beliefs of HCPs and office staff. Results: Before and after the intervention, the earliest age of first Pap screening was very young. HCP did not always require Pap screening for contraception initiation: 48% pre-intervention and 71% post-intervention. No adolescents had serious abnormal Pap results. Conclusions: Resistance to change was apparent from the office staff. Having written guidelines and meeting periodically to discuss how care is provided will help keep staff discussions with patients congruent with HCP's practices.

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