Provider Adherence to the 2019 American Society for Colposcopy and Cervical Pathology Guidelines: A Retrospective Review

Background: In 2019, the American Society for Colposcopy and Cervical Pathology (ASCCP) released updated guidelines for cervical cancer screening. While these guidelines are heavily evidence-based, we anticipated poor adherence as providers have been notoriously non-adherent to prior cervical cancer screening guidelines. The purpose of this study is to assess provider adherence to the 2019 ASCCP guidelines, within a single group of academic ObGyn providers. Methods: We collected all cytology and HPV requisition forms ordered by a group of ObGyn providers from November 2022 to February 2023. Each patient’s prior cervical cancer screening results were determined through a review of the laboratory electronic database and the patient’s electronic medical record. Screening results, type of test ordered, and the time interval between successive tests were compiled and compared against the 2019 ASCCP guidelines to determine whether a given order was adherent. Adherence rates were also analyzed by provider, by clinic, and by month, and reported as median adherence rates with interquartile ranges. Results: A total of 336 requisition forms from 14 clinics and 24 providers were included in the analysis. We found an overall adherence rate of 65.2%. The median adherence rate per provider was 74.0% (57.5% to 83.3%). The median adherence rate per clinic was 67.3% (53.6% to 82.3%). There was no significant trend in adherence per given month with adherence rates of 70.9% in November, 65.0% in December, 53.0% in January, and 74.2% in February. The most common reasons for non-adherence were 1) too long of an interval between successive screen/follow up (41%) 2) incorrect order (35%), and 3) too short of an interval between successive screen/follow-up (16.2%). From the last group, 41.7% were patients who did not show up for appointments. Conclusions: Within our group, the overall adherence to the 2019 ASSCP guidelines is suboptimal (65.2%). The most common reason for non-adherence was too long of an interval between successive screen/follow up results. This suggests that non-adherence may be influenced by factors outside of a provider’s control. However, the high rate of incorrect orders indicates a lack of knowledge, which may be improved with outreach and education.