Syphilis testing performance in Aboriginal primary health care: exploring impact of continuous quality improvement over time
Armita Adily
A F , Seham Girgis B , Catherine D’Este C , Veronica Matthews D and Jeanette E. Ward E
+ Author Affiliations
- Author Affiliations
A The Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW 2052, Australia.
B S&K Girgis Medical Service, 1/13–15 Kingsway, Cronulla, NSW 2230, Australia.
C National Centre for Epidemiology and Population Health, The Australian National University, 62 Mills Road, Canberra, ACT 0200, Australia.
D University Centre for Rural Health, The University of Sydney, 61 Uralba Street, Lismore, NSW 2480, Australia.
E Nulungu Research Institute, University of Notre Dame, 88 Guy Street, Broome, WA 6725, Australia.
F Corresponding author. Email: Armita.Adily@unsw.edu.au
Australian Journal of Primary Health 26(2) 178-183 https://doi.org/10.1071/PY19070
Submitted: 1 April 2019 Accepted: 1 October 2019 Published: 3 February 2020
Abstract
Data from 110 primary healthcare clinics participating in two or more continuous quality improvement (CQI) cycles in preventive care, which included syphilis testing performance (STP) for Aboriginal and Torres Strait Islander people aged between 15 and 54 years, were used to examine whether the number of audit cycles including syphilis testing was associated over time with STP improvement at clinic level in this specific measure of public health importance. The number of cycles per clinic ranged from two to nine (mode 3). As shown by medical record audit at entry to CQI, only 42 (38%) clinics had tested or approached 50% or more of their eligible clients for syphilis in the prior 24 months. Using mixed effects logistic regression, it was found that the odds of a clinic’s STP relative to its first cycle increased only modestly. Counterintuitively, clinics undertaking the most preventive health CQI cycles tended to have the lowest STP throughout. Participation in a general preventive care CQI tool was insufficient to achieve and sustain high rates of STP for Aboriginal and Torres Strait Islander people required for public health benefit. Improving STP requires dedicated effort and greater understanding of barriers to effective CQI within and beyond clinic control.
Additional keywords: Indigenous health care, public health, sexually transmissible infections (STIs).
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