External audit of providers of the Cervical Cancer Prevention Programme in Poland in 2016/2017

Abstract

Introduction. The Cervical Cancer (CC) Prevention Programme includes 3 phases: basic (Pap smear collection), diagnostic (Pap smear evaluation) and in-depth (colposcopy/biopsy in case of abnormal smear test findings). The Programme service providers are subject to an external audit and this publication’s objective is to analyse its results from 2016 and the first half of 2017.

Materials and methods. The audit of the Programme performance in the period 01.01.2016–30.06.2017 was carried out by external auditors by way of personal visits to the offices of the service providers and by way of direct data retrieval. The audit covered 12% (198) of the basic phase, 100% (66) of the diagnostic phase and 100% (62) of the in-depth phase facilities. The Polish National Health Fund (NHF) did not make available the routinely collected data for the purpose of audit. Audit data collected in the developed protocols were analysed.

Results. The number of Pap smears (2,028,988) and the number of colposcopies (13,636) outside the Programme was, respectively, more than two and three times higher than in the Programme (cytology — 801,640, colposcopy — 3929). The performance of the procedures (Programme vs outside the Programme) was highly variable depending on the provider. The percentage of Pap smears unsuitable for evaluation did not differ significantly between gynaecologists and midwives. All audited cytological laboratories carried out rescreening of samples. Biopsy was not performed in 11% (2016) and 15% (2017) of colposcopy laboratories. Inaccuracies were found in 19% (61) of the audit protocols.

Discussion. Significantly higher number of procedures performed outside the Programme results from lower renu­meration of procedures within the Programme. Variable provider's preferences in the mode of procedures execution indicates that with the use of appropriate organisational solutions it would be possible to reduce opportunistic screening, which is of unknown quality. The quality of Pap smear sample collection in the case of gynaecologists and midwives is the same, but the number of primary care provider (PCP) facilities where midwives collect smears is very limited. The inaccuracies noted in the audit protocols indicate that the lack of access to data collected by the National Health Fund decreased the quality of the audit carried out and the reliability of the data obtained.

Conclusions. Restoring full access to data collected by the NHF is crucial for the Programme audit quality. Measures should be implemented to reduce opportunistic screening and shift the stream of tests to the Programme (both at the basic and at the in-depth phase), and to increase the availability of tests in PCP facilities through training for midwives.