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Urgent Care Centers Can Promote Preventative Care for Women

     Urgent care centers and emergency departments are somewhat unique in their roles as care institutions. In addition to the work they do treating patients suffering from acute or life-threatening conditions, they often fulfill the role of primary care provider for those patients who lack a regular primary care physician. Often, patients without insurance who have no access options will go to the emergency room or urgent care clinic as a last resort when they can no longer delay treatment and being to suffer. Because many patients rely upon the services of emergency and urgent care departments, public health advocates and others have begun to examine how preventative care can be incorporated into the services normally provided at these locations. The idea behind these types of campaigns is to catch patients with treatable conditions early in order to prevent them from developing more severe forms of disease. A recent study examined this model in the implementation of cervical cancer screening.

Sadly, cervical cancer is the most common cancer in all women worldwide. Dysplasia, or lesions on the surface of the cervix can turn malignant if they are not treated in the early stages. The malignancies develop slowly over a period of several years, so screening programs are very effective if they catch the problem before it turns into full-blown disease. Pap smears (the tests used to find cervical changes) have been shown to reduce mortality rates from cervical cancer by as much as 60%. Therefore, widespread screening programs are known to help save lives. Unfortunately, however, even in the United States, not all women have access to this type of care. The rates at which women receive pap smears are influenced by their socioeconomic status and education levels. Studies have shown that 38% of women who earn less than $10,000 per year failed to get a routine pap smear, while 42% of women with less than a high school degree fail to get an annual pap smear. These statistics are important because they suggest that the types of patients who are most likely to receive care at emergency clinics or urgent care centers are those that are least likely to have health insurance or knowledge of the importance of preventative pap smears.

To study whether an urgent care center could also successfully offer pap screening exams to women, a recent research study decided to test the model on sample populations. To do this, they performed a prospective randomized trial at a public teaching hospital. Women who sought care for any condition that required a pelvic exam were invited to participate, and their outcomes were compared with a group of women who presented to the regular gynecology clinic for scheduled pap smears. In both groups, researchers tracked information such as pap smear adequacy, pap smear abnormality, and follow-up rates. Women who came to the urgent care clinic for symptoms such as abdominal pain, vaginal bleeding, or pelvic pain were randomly divided into two groups: one group was instructed to receive a pap smear at a later date at the clinic, while the other group was offered a pap smear during their urgent care exam. The group that received pap smears right away in the urgent care setting were identified as the intervention group.

In total, 197 eligible women came to the urgent care clinic during the time of the study. The women who refused to participate did not differ from those who participated in age, ethnicity, or insurance status. The intervention group included 111 individuals, and 86 women were assigned to the follow-up group (those instructed to come back later for a pap smear). The group of women instructed to come back later for a pap smear did not overwhelmingly comply with this advice - only 17% returned as instructed, while 100% of the women offered a pap smear at the urgent care clinic received one. Also surprising was that out of the women who received abnormal results at the clinic, only 23.8% followed up with an additional appointment. In the group of women with regularly scheduled pap exams, the rate was 60%, yet the rate of abnormality was the same in both groups at 20%.

From this the authors concluded that while urgent care centers are a good way to reach women who might not otherwise receive pap exams, the women in these populations were also less likely to follow up and receive care if their test results indicated it was necessary. Nonetheless, the study did demonstrate that public hospitals and their associated emergency or urgent care centers were possible allies in the fight against cervical cancer, and that the pap tests obtained during screenings for other illnesses at the clinic resulted in the same amount of clinical accuracy as those performed during a routine ob-gyn checkup. The authors suggest that the most effective strategy should be to develop screening programs that also have a more effective and wide-reaching follow-up component.Education programs designed to explain the imporatance of regular exams to women could also be undertaken.

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Posted on 2013-06-09, By: *

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