Celebrating
at the University of Michigan
Fall 2015
New Pap Smear Schedule Led to Fewer Chlamydia Tests A resident original research project leads to an important publication and national news coverage.
In This Issue From the Chair 2 Development 3 Education Mission 5 Clinical Mission 9 Research Mission 12 Faculty Activity 15
It’s a tale of two tests: one for early signs of cervical cancer, the other for a sexually transmitted disease. But a new study suggests that a change in the recommended schedule for one may have dramatically lowered the chances that young women would get the other. Results published in the Annals of Family Medicine show the unintended consequences of changes to national health test guidelines: the potential for doctors to fall behind on ordering other tests that screen for serious health problems. In this case, the two tests are Pap smears and screens for the most common sexually transmitted disease: chlamydia. Allison N. Ursu, M.D., lecturer, lead author of the study, began looking at the guideline change and its unintentional effects during her intern year in 2011. Shortly before that time, recommendations for most women under age 25 called for Pap smears earlier and more often, and chlamydia screening once they were sexually active. Doctors could take samples during the same pelvic exam. But the Pap smear schedule changed, removing annual tests before age 21 to reduce the chance of unneeded follow-up tests. “With the change in screening, we wanted to see if there were other implications, and indeed a decrease in chlamydia screening occurred even
though the number of visits by young women was about the same,” said Dr. Ursu. Dr. Ursu completed a project on this topic and presented it as part of the Department’s Resident Original Research Project Day and at the Michigan Family Medicine Research Day during her third year of residency in 2014. However, upon completion of the residency requirements, she continued working with her mentors through her fellowship in women’s health and as she became a Department faculty member in order to fully develop her research and bring it to publication. She and her mentors (now colleagues) Mack T. Ruffin IV, M.D., M.P.H., the Dr. Max and Buena Lichter Research Professor in Family Medicine, and Ananda Sen, Ph.D., the Lee A. Green Collegiate Research Professor in Family Medicine, looked at the tests given to sexually active young women aged 16 to 21 years with no chlamydia symptoms who came to U-M’s five family medicine clinics in the year before the new Pap test guideline and two years later. Those in the earlier group were nearly 14 times more likely to get a chlamydia test than those seen later, even though there was no drop in clinic visits by such patients. The clinics have since added an electronic reminder to prompt doctors to order a chlamydia test once a year for
http://medicine.umich.edu/dept/family-medicine
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