Clinic predictors of better syphilis testing in Aboriginal primary healthcare: a promising opportunity for primary healthcare service managers
Barbara Nattabi
A F , Seham Girgis B , Veronica Matthews C , Ross Bailie C and Jeanette E. Ward D E
A Western Australian Centre for Rural Health, University of Western Australia, 167 Fitzgerald Street, Geraldton, WA 6530, Australia.
B S&K Girgis Medical Service, 1/13–15 Kingsway, Cronulla, NSW 2230, Australia.
C The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW 2480, Australia.
D Nulungu Research Institute, University of Notre Dame, Broome Campus, Guy Street, Broome, WA 6725, Australia.
E Western Australia Country Health Service, Kimberley, PO Box 525, Broome, WA 6725, Australia.
F Corresponding author. Email: barbara.nattabi@uwa.edu.au
Australian Journal of Primary Health 24(4) 350-358 https://doi.org/10.1071/PY17148
Submitted: 16 October 2017 Accepted: 10 April 2018 Published: 30 July 2018
Abstract
Integration of public health and primary healthcare (PHC) is a hallmark of comprehensive PHC to reduce inequitable rates of preventable diseases in communities at risk. In the context of a syphilis outbreak among Indigenous people in Northern Australia, the association between PHC clinic factors and syphilis testing performance (STP) was examined to produce empirical insights for service managers. Data from the Audit and Best Practice for Chronic Disease National Program (2012–14) were analysed to examine associations between clinic factors and STP (proportion of clients ≥15 years who were tested for or offered a test for syphilis in the prior 24 months). Univariate analyses were conducted for 77 clinics and a subset of 67 remote clinics. Multivariate linear regression models were used to determine independent predictors of STP. Syphilis testing performance across PHC clinics ranged from 0 to 93.8% (median 46.5%). In univariate analysis, Delivery system design, which refers to clinic infrastructure, staffing profile and allocation of roles and responsibilities, was significantly associated with higher STP in all clinics (P = 0.004) and in the subset of remote clinics (P = 0.008). Syphilis testing performance was higher in the Northern Territory compared to other states, in remote clinics and clinics serving smaller populations. In multivariate analysis, Delivery system design and jurisdiction remained associated with STP. To better realise the potential of comprehensive PHC, service managers should focus on PHC delivery system design to enhance the current syphilis outbreak response.
Additional keywords: delivery of healthcare, Indigenous health services, preventive health services, quality of healthcare.
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