Browsing by Author "Baade P.D."
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Item Service level factors associated with cervical screening in Aboriginal and Torres Strait Islander primary health care centres in Australia.(2019-11-04) Diaz A.; Vo B.; Baade P.D.; Matthews V.; Nattabi B.; Bailie J.; Whop L.J.; Bailie R.; Garvey G.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.Copyright © 2019 by the authors. Licensee MDPI, Basel, Switzerland.Item Time to clinical investigation for Indigenous and non-Indigenous Queensland women after a high grade abnormal pap smear, 2000-2009.(2017-02-16) Whop L.J.; Baade P.D.; Brotherton J.M.L.; Canfell K.; Cunningham J.; Gertig D.; Lokuge K.; Garvey G.; Moore S.P.; Diaz A.; O'Connell D.L.; Valery P.; Roder D.M.; Condon J.R.Objectives: To investigate time to follow-up (clinical investigation) for Indigenous and non-Indigenous women in Queensland after a high grade abnormality (HGA) being detected by Pap smear. Design, setting, participants: Population-based retrospective cohort analysis of linked data from the Queensland Pap Smear Register (PSR), the Queensland Hospital Admitted Patient Data Collection, and the Queensland Cancer Registry. 34 980 women aged 20e68 years (including 1592 Indigenous women) with their first HGA Pap smear result recorded on the PSR (index smear) during 2000e2009 were included and followed to the end of 2010. Main Outcome Measure(s): Time from the index smear to clinical investigation (histology test or cancer diagnosis date), censored at 12 months. Result(s): The proportion of women who had a clinical investigation within 2 months of a HGA finding was lower for Indigenous (34.1%; 95% CI, 31.8e36.4%) than for non-Indigenous women (46.5%; 95% CI, 46.0e47.0%; unadjusted incidence rate ratio [IRR], 0.65; 95% CI, 0.60e0.71). This difference remained after adjusting for place of residence, area-level disadvantage, and age group (adjusted IRR, 0.74; 95% CI, 0.68e0.81). However, Indigenous women who had not been followed up within 2months were subsequently more likely to have a clinical investigation than non-Indigenous women (adjusted IRR for 2e4 month interval, 1.21; 95% CI, 1.08e1.36); by 6 months, a similar proportion of Indigenous (62.2%; 95% CI, 59.8e64.6%) and non-Indigenous women (62.8%; 95% CI, 62.2e63.3%) had been followed up. Conclusion(s): Prompt follow-up after a HGA Pap smear finding needs to improve for Indigenous women. Nevertheless, slow follow-up is a smaller contributor to their higher cervical cancer incidence and mortality than their lower participation in cervical screening.Copyright ©2017 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved.