See related article, page 933.
"Cervical Cancer Screening in an Urban Emergency Department," by Hogness et al, in this issue of Annals, demonstrates that good-quality Pap smears can be obtained in the emergency department, that 8% of patients had cervical dysplasia or carcinoma, and that 70% complied with follow-up. Although the study initially appears to have limited relevance, it raises crucial questions about the role of the ED in preventive care. In this commentary, we address the broader question: What is the responsibility of emergency medicine in primary care?
The location of the study, Highland General Hospital, exemplifies the problems facing public hospitals in the 1990s. In such hospitals, patients wait many hours to be seen in the EDs;.many leave without being seen.l, 2 The clinics are so overburdened that patients can wait months for follow-up appointments, where, as the authors report, "Follow-up procedures on those who returned...were still occasionally inadequate."
Limited clinical and administrative resources thwart attempts at improving such facilities. It is difficult to collect the data necessary to evaluate proposed changes. Medical record retrieval is problematic, and clinicians may be too overwhelmed to cooperate with data collection. When longitudinal information is necessary, the anger and helplessness felt by many inner-city patients decrease the probability that they will comply with follow-up instructions.
The paper brings us encouraging news from such an environment. The authors show that it is possible to conduct clinically useful, policy-relevant research in such a setting. With a small research team, they were able to enlist the cooperation of clinicians, collect data in the ED, and obtain follow-up data on most of the patients studied.
The findings are impressive. Twenty-nine percent of women did not know when they had last received a Pap smear. Eight percent showed evidence of dysplasia or carcinoma, mandating follow-up, four times the proportion in comparison groups cited by the authors. A disproportionate number of young, black, and Hispanic women had AUGUST1992 21:8 ANNALS OF EMERGENCY MEDICINE 982/1