Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia
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 id...
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doaj-04757b70a735469db566cbae31500a502020-11-25T02:36:31ZengMDPI AGInternational Journal of Environmental Research and Public Health1660-46012019-09-011619363010.3390/ijerph16193630ijerph16193630Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in AustraliaAbbey Diaz0Brenda Vo1Peter D. Baade2Veronica Matthews3Barbara Nattabi4Jodie Bailie5Lisa J. Whop6Ross Bailie7Gail Garvey8Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, AustraliaWellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, AustraliaWellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, AustraliaUniversity Centre for Rural Health, The University of Sydney, Lismore 2480, AustraliaSchool of Population and Global Health, The University of Western Australia, Crawley 6009, AustraliaUniversity Centre for Rural Health, The University of Sydney, Lismore 2480, AustraliaWellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, AustraliaUniversity Centre for Rural Health, The University of Sydney, Lismore 2480, AustraliaWellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, AustraliaAboriginal 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.https://www.mdpi.com/1660-4601/16/19/3630cervical cancer screeningcontinuous quality improvementprimary health careaboriginal and torres strait islanderindigenousaustraliapap smearclinical auditsprimary carepreventive health |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Abbey Diaz Brenda Vo Peter D. Baade Veronica Matthews Barbara Nattabi Jodie Bailie Lisa J. Whop Ross Bailie Gail Garvey |
spellingShingle |
Abbey Diaz Brenda Vo Peter D. Baade Veronica Matthews Barbara Nattabi Jodie Bailie Lisa J. Whop Ross Bailie Gail Garvey Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia International Journal of Environmental Research and Public Health cervical cancer screening continuous quality improvement primary health care aboriginal and torres strait islander indigenous australia pap smear clinical audits primary care preventive health |
author_facet |
Abbey Diaz Brenda Vo Peter D. Baade Veronica Matthews Barbara Nattabi Jodie Bailie Lisa J. Whop Ross Bailie Gail Garvey |
author_sort |
Abbey Diaz |
title |
Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia |
title_short |
Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia |
title_full |
Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia |
title_fullStr |
Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia |
title_full_unstemmed |
Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia |
title_sort |
service level factors associated with cervical screening in aboriginal and torres strait islander primary health care centres in australia |
publisher |
MDPI AG |
series |
International Journal of Environmental Research and Public Health |
issn |
1660-4601 |
publishDate |
2019-09-01 |
description |
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. |
topic |
cervical cancer screening continuous quality improvement primary health care aboriginal and torres strait islander indigenous australia pap smear clinical audits primary care preventive health |
url |
https://www.mdpi.com/1660-4601/16/19/3630 |
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