PAPANICOLAOU SMEAR RECOMMENDATIONS, PATIENT COMPLAINTS, AND PATIENT SATISFACTION IN MANAGED-CARE MEDICAL ORGANIZATIONS

This study sought to determine whether primary-care physicians, practicing in different types of managed-care medical organizations, were recommending Papanicolaou (Pap) smear screening to their patients. The author also wished to determine whether Pap smear recommendation rates correlated with characteristics of the organizations, with complaint rates, or with survey-based satisfaction measures. Randomly selected medical records (N = 10,978) were audited of women older than 18 years of age, insured by a single California health maintenance organization, who were being cared for by 81 medical organizations. It was determined whether women with an established primary-care physician were receiving recommendations for Pap smear testing within a 2-year period. Information on quality-related patient complaints from these organizations also was tabulated, and a telephone-based patient satisfaction Survey on 1,700 members from the 46 largest organizations was performed. Overall, the study's Pap smear standard was met 83.2% of the time, with a range of 30% to 100% between organizations. performance was unrelated to organization size, type, number of patients, percentage of board-certified physicians, or whether the organization permitted self-referral to an obstetrics/gynecology physician. Performance was also unrelated to complaint rates or survey measures of patient satisfaction. Performance was, however, positively correlated with the number of prepaid patients per primary care physician (r = 0.28, P = 0.01). Complaint rates and survey satisfaction measures were strongly correlated with each other (r = -0.48 and -0.57, P = 0.001). The results suggest that organizations with greater concentrations of managed care may have better processes to encourage Pap smear screening. They also suggest that a potential measure of organizational quality, Pap smear recommendation rates, may not correlate with complaint rates or survey-based satisfaction levels. This reinforces the need for multiple measures of organizational quality.