On-site colposcopy services in a family practice residency clinic: impact on physician test-ordering behavior, patient compliance, and practice revenue generation.

BACKGROUND Using colposcopy as a model, we examined the impact of introducing a new diagnostic technology into the ambulatory primary care setting. METHODS Records of patients with abnormal findings on Papanicolaou smears were reviewed from three study periods: 1 year before, 1 year after, and 5 years after initiation of on-site colposcopy services. Data analyzed include physician management decisions, site of colposcopic service, and patient compliance. Practice revenue estimates were based upon patterns of physician management and patient compliance found during each study period. RESULTS Management of low-grade squamous intraepithelial lesions varied during each study period. By period 3, however, most patients were undergoing colposcopy (P = 0.03). High-grade squamous intraepithelial lesions were uniformly managed with colposcopy during all study periods (P < 0.001). Introduction of on-site colposcopic services resulted in a rapid shift to the on-site location for evaluation of low-grade squamous intraepithelial lesions and a more gradual shift to the on-site location for evaluation of high-grade squamous intraepithelial lesions. Patient compliance was not affected by the introduction of on-site services. On-site colposcopy resulted in a nearly 100 percent transfer of revenue to the practice, but the economic benefit was quite modest. CONCLUSIONS Although offering on-site colposcopy services might have had some impact on physician management of low-grade squamous intraepithelial lesions, the lack of benefit regarding patient compliance, the relatively small patient volume for this procedure, and its modest impact on practice revenue cause us to question the value of including colposcopy in everyday practice.