Integration of monitoring preventive activities related to early detection of cervical cancer in the Republic of Croatia

Abstract

The National Program for the Early Detection of Cervical Cancer (further: the Program) was conducted in the Republic of Croatia as organised national screening from December 1, 2012, until 2016 using the PAP test as the screening method. Concurrently, opportunistic screening with the PAP test has been carried out for decades and is provided by primary gynaecologists. Although one of the goals of organised national screening is the abolition of opportunistic screening, one of the temporary possibilities for improving the Program is the integration of organised national screening and opportunistic screening, considering the availability of gynaecology teams at the level of primary care. The prerequisite for the integration is a high-quality IT solution, which has been available as of recently. This IT solution was built on a common platform for all three national programs for early detection of cancer (breast, colon and cervix), and is connected to the systems of CEZIH (Central Health Information System of the Republic of Croatia) and ZOROH (Business Database of the Croatian Health Insurance Fund (HZZO)), which are important sources of data on citizens, and are currently fully functional with defined business processes. The Program is implemented and all women between the ages of 25 and 64 are invited by paper invitation by county public health institutes, with the screening interval of three years. Invitations to women who have had a PAP test within the public health system in the past year (based on the HZZO invoices) have been temporarily postponed. Along with the invitation, the name of the woman’s gynaecologist is included, and in case the woman is not on any gynaecologist’s list, names of three available nearby gynaecologists are listed with whom the woman can register if she so wishes. The woman comes to the gynaecologist with the invitation (which also includes a kupovnica or the paid referral for the Program), a sample is taken and sent to the cytological laboratory, and the findings are sent to her gynaecologist once available. ... With this program integration, the responsibility of gynaecologists, for whom this is one of the basic preventive activities, would be increased, and women without a chosen gynaecologist would be further encouraged to choose one, which would ensure better coverage of the female population with primary care gynaecology services.