Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia.
Cancer Research Centre, Cancer Council Queensland, Herston 4006, Australia.
Int J Environ Res Public Health. 2019 Sep 27;16(19):3630. doi: 10.3390/ijerph16193630.
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.
澳大利亚原住民和托雷斯海峡岛民妇女的宫颈癌发病率和死亡率明显高于其他澳大利亚女性。在这项研究中，我们评估了澳大利亚各地的原住民初级保健中心（PHC）就诊的妇女接受宫颈癌筛查的记录，并确定了与筛查覆盖率中心间差异相关的服务水平因素。我们分析了来自澳大利亚五个州/领地的 135 个原住民 PHC 中心的 3801 名年龄在 20-64 岁之间的 PHC 客户的临床审计记录，这些客户参加了 Audit for Best Practice in Chronic Disease（ABCD）持续质量改进（CQI）计划，时间跨度为 2005 年至 2014 年。多水平逻辑回归模型用于确定与筛查相关的服务水平因素，同时考虑到客户水平因素的差异。在所参与的 PHC 中心中，有记录的过去两年内进行了宫颈筛查的客户比例存在很大差异（中位数为 50%，四分位距（IQR）：29-67%），多年来和审计周期都存在这种差异。中心水平因素解释了 40%的差异；客户水平因素并没有减少中心间的差异。筛查覆盖率与参加 CQI 计划的时间较长和非常偏远的地理位置有关。原住民 PHC 中心在为澳大利亚原住民和托雷斯海峡岛民妇女提供宫颈癌筛查方面发挥着重要作用。因此，他们的领导对于确保澳大利亚消除宫颈癌的公共卫生承诺包括澳大利亚原住民和托雷斯海峡岛民妇女至关重要。对 CQI 的持续承诺可能会改善 PHC 中心提供宫颈癌筛查的服务；然而，组织、地理和环境等可能影响服务提供的因素，需要进一步调查。
