Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia

Abbey Diaz, Brenda Vo, Peter D. Baade, Veronica Matthews, Barbara Nattabi, Jodie Bailie, Lisa J. Whop, Ross Bailie, Gail Garvey

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Aboriginal and Torres Strait Islander women have significantly higher cervical cancer incidence and mortality than other Australian women. In this study, we assessed the documented delivery of cervical screening for women attending Indigenous Primary Health Care (PHC) centres across Australia and identified service-level factors associated with between-centre variation in screening coverage. We analysed 3801 clinical audit records for PHC clients aged 20-64 years from 135 Indigenous PHC centres participating in the Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program across five Australian states/territories during 2005 to 2014. Multilevel logistic regression models were used to identify service-level factors associated with screening, while accounting for differences in client-level factors. There was substantial variation in the proportion of clients who had a documented cervical screen in the previous two years across the participating PHC centres (median 50%, interquartile range (IQR): 29-67%), persisting over years and audit cycle. Centre-level factors explained 40% of the variation; client-level factors did not reduce the between-centre variation. Screening coverage was associated with longer time enrolled in the CQI program and very remote location. Indigenous PHC centres play an important role in providing cervical screening to Aboriginal and Torres Strait Islander women. Thus, their leadership is essential to ensure that Australia's public health commitment to the elimination of cervical cancer includes Aboriginal and Torres Strait Islander women. A sustained commitment to CQI may improve PHC centres delivery of cervical screening; however, factors that may impact on service delivery, such as organisational, geographical and environmental factors, warrant further investigation.

    Original languageEnglish
    Pages (from-to)1-12
    Number of pages12
    JournalInternational Journal of Environmental Research and Public Health
    Volume16
    Issue number19
    DOIs
    Publication statusPublished - 1 Oct 2019

    Fingerprint

    Primary Health Care
    Quality Improvement
    Uterine Cervical Neoplasms
    Logistic Models
    Clinical Audit
    Practice Guidelines
    Chronic Disease
    Public Health
    Delivery of Health Care
    Mortality
    Incidence

    Cite this

    @article{8e90b7e44f704e8fb44edbfdfdde22ed,
    title = "Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia",
    abstract = "Aboriginal and Torres Strait Islander women have significantly higher cervical cancer incidence and mortality than other Australian women. In this study, we assessed the documented delivery of cervical screening for women attending Indigenous Primary Health Care (PHC) centres across Australia and identified service-level factors associated with between-centre variation in screening coverage. We analysed 3801 clinical audit records for PHC clients aged 20-64 years from 135 Indigenous PHC centres participating in the Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program across five Australian states/territories during 2005 to 2014. Multilevel logistic regression models were used to identify service-level factors associated with screening, while accounting for differences in client-level factors. There was substantial variation in the proportion of clients who had a documented cervical screen in the previous two years across the participating PHC centres (median 50{\%}, interquartile range (IQR): 29-67{\%}), persisting over years and audit cycle. Centre-level factors explained 40{\%} of the variation; client-level factors did not reduce the between-centre variation. Screening coverage was associated with longer time enrolled in the CQI program and very remote location. Indigenous PHC centres play an important role in providing cervical screening to Aboriginal and Torres Strait Islander women. Thus, their leadership is essential to ensure that Australia's public health commitment to the elimination of cervical cancer includes Aboriginal and Torres Strait Islander women. A sustained commitment to CQI may improve PHC centres delivery of cervical screening; however, factors that may impact on service delivery, such as organisational, geographical and environmental factors, warrant further investigation.",
    keywords = "Aboriginal and Torres Strait Islander, Australia, cervical cancer screening, clinical audits, continuous quality improvement, Indigenous, Pap smear, preventive health, primary care, primary health care",
    author = "Abbey Diaz and Brenda Vo and Baade, {Peter D.} and Veronica Matthews and Barbara Nattabi and Jodie Bailie and Whop, {Lisa J.} and Ross Bailie and Gail Garvey",
    year = "2019",
    month = "10",
    day = "1",
    doi = "10.3390/ijerph16193630",
    language = "English",
    volume = "16",
    pages = "1--12",
    journal = "International Journal of Environmental Research and Public Health",
    issn = "1660-4601",
    publisher = "Open Access",
    number = "19",

    }

    Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia. / Diaz, Abbey; Vo, Brenda; Baade, Peter D.; Matthews, Veronica; Nattabi, Barbara; Bailie, Jodie; Whop, Lisa J.; Bailie, Ross; Garvey, Gail.

    In: International Journal of Environmental Research and Public Health, Vol. 16, No. 19, 01.10.2019, p. 1-12.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia

    AU - Diaz, Abbey

    AU - Vo, Brenda

    AU - Baade, Peter D.

    AU - Matthews, Veronica

    AU - Nattabi, Barbara

    AU - Bailie, Jodie

    AU - Whop, Lisa J.

    AU - Bailie, Ross

    AU - Garvey, Gail

    PY - 2019/10/1

    Y1 - 2019/10/1

    N2 - Aboriginal and Torres Strait Islander women have significantly higher cervical cancer incidence and mortality than other Australian women. In this study, we assessed the documented delivery of cervical screening for women attending Indigenous Primary Health Care (PHC) centres across Australia and identified service-level factors associated with between-centre variation in screening coverage. We analysed 3801 clinical audit records for PHC clients aged 20-64 years from 135 Indigenous PHC centres participating in the Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program across five Australian states/territories during 2005 to 2014. Multilevel logistic regression models were used to identify service-level factors associated with screening, while accounting for differences in client-level factors. There was substantial variation in the proportion of clients who had a documented cervical screen in the previous two years across the participating PHC centres (median 50%, interquartile range (IQR): 29-67%), persisting over years and audit cycle. Centre-level factors explained 40% of the variation; client-level factors did not reduce the between-centre variation. Screening coverage was associated with longer time enrolled in the CQI program and very remote location. Indigenous PHC centres play an important role in providing cervical screening to Aboriginal and Torres Strait Islander women. Thus, their leadership is essential to ensure that Australia's public health commitment to the elimination of cervical cancer includes Aboriginal and Torres Strait Islander women. A sustained commitment to CQI may improve PHC centres delivery of cervical screening; however, factors that may impact on service delivery, such as organisational, geographical and environmental factors, warrant further investigation.

    AB - Aboriginal and Torres Strait Islander women have significantly higher cervical cancer incidence and mortality than other Australian women. In this study, we assessed the documented delivery of cervical screening for women attending Indigenous Primary Health Care (PHC) centres across Australia and identified service-level factors associated with between-centre variation in screening coverage. We analysed 3801 clinical audit records for PHC clients aged 20-64 years from 135 Indigenous PHC centres participating in the Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program across five Australian states/territories during 2005 to 2014. Multilevel logistic regression models were used to identify service-level factors associated with screening, while accounting for differences in client-level factors. There was substantial variation in the proportion of clients who had a documented cervical screen in the previous two years across the participating PHC centres (median 50%, interquartile range (IQR): 29-67%), persisting over years and audit cycle. Centre-level factors explained 40% of the variation; client-level factors did not reduce the between-centre variation. Screening coverage was associated with longer time enrolled in the CQI program and very remote location. Indigenous PHC centres play an important role in providing cervical screening to Aboriginal and Torres Strait Islander women. Thus, their leadership is essential to ensure that Australia's public health commitment to the elimination of cervical cancer includes Aboriginal and Torres Strait Islander women. A sustained commitment to CQI may improve PHC centres delivery of cervical screening; however, factors that may impact on service delivery, such as organisational, geographical and environmental factors, warrant further investigation.

    KW - Aboriginal and Torres Strait Islander

    KW - Australia

    KW - cervical cancer screening

    KW - clinical audits

    KW - continuous quality improvement

    KW - Indigenous

    KW - Pap smear

    KW - preventive health

    KW - primary care

    KW - primary health care

    UR - http://www.scopus.com/inward/record.url?scp=85072778790&partnerID=8YFLogxK

    U2 - 10.3390/ijerph16193630

    DO - 10.3390/ijerph16193630

    M3 - Article

    VL - 16

    SP - 1

    EP - 12

    JO - International Journal of Environmental Research and Public Health

    JF - International Journal of Environmental Research and Public Health

    SN - 1660-4601

    IS - 19

    ER -