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 and Gail Garvey
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Abbey Diaz: Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia
Brenda Vo: Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia
Peter D. Baade: Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia
Veronica Matthews: University Centre for Rural Health, The University of Sydney, Lismore 2480, Australia
Barbara Nattabi: School of Population and Global Health, The University of Western Australia, Crawley 6009, Australia
Jodie Bailie: University Centre for Rural Health, The University of Sydney, Lismore 2480, Australia
Lisa J. Whop: Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia
Ross Bailie: University Centre for Rural Health, The University of Sydney, Lismore 2480, Australia
Gail Garvey: Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia

IJERPH, 2019, vol. 16, issue 19, 1-12

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: cervical cancer screening; continuous quality improvement; primary health care; Aboriginal and Torres Strait Islander; Indigenous; Australia; Pap smear; clinical audits; primary care; preventive health (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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