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Adherence to Management Recommendations in Patients Diagnosed With High-Grade Cervical Dysplasia [7]

INTRODUCTION: The management of high-grade cervical dysplasia includes multiple options: observation, ablation, or excision. We evaluated patient adherence to health care provider management recommendations for high-grade cervical lesions in an academic safety net hospital. METHODS: This was a retrospective cohort study identifying patients with biopsy-proven high-grade cervical dysplasia (cervical intraepithelial neoplasia 2 or 3) through pathology records between January 1, 2008, and December 31, 2012. Patients with human immunodeficiency virus or lupus or who were pregnant were excluded. Patient demographics, recommended management, and patient adherence were extracted from the chart. Complete adherence was defined as completion of follow-up recommendations within 6 months of the recommended follow-up date. The primary outcome was rate of complete adherence to management recommendations. Descriptive statistics, univariate analysis, and multivariate logistic regression were performed. RESULTS: A total of 684 patients met the inclusion criteria. The complete adherence rate was 89% (n=606). Those who completed follow-up were older (31 compared with 29 years old, P=.031), more likely to use long-acting reversible contraception or sterilization for contraception (92% compared with 87%, P=.036), and more likely to have had excision recommended (90% compared with 83%, P=.009). In multivariate analysis, those patients who had observation recommended (n=46) were less likely to complete follow-up (70%, odds ratio 0.26, confidence interval 0.13–0.51). The observation group was noted to be younger (23 compared with 32 years, P<.001), with lower parity (1.4 compared with 2.1, P<.001). No variables were associated with complete adherence in the observation group. CONCLUSION: Patients were overall highly adherent with management recommendations in the setting of high-grade cervical dysplasia. Those patients recommended to undergo observation were least likely to be adherent.