Uptake of a sexual health clinical audit tool and its impact on sexual health service delivery in Aboriginal and Torres Strait Islander primary health care services
Eight years ago, the Audit and Best Practice for Chronic Disease (ABCD) project rolled out across Australia. The project concentrates on encouraging Aboriginal health care services to implement continuous quality improvement (CQI) processes to enhance care outcomes for their patients and eliminate barriers to providing best-practice quality care.
Existing research indicates that:
- Aboriginal and Torres Strait Islander Australians (hereafter Indigenous) continue to suffer disproportionately from sexually transmitted infections (STIs) and blood borne viruses (BBVs) compared to non-Indigenous Australians.
- Chlamydia, gonorrhoea and syphilis are over three, thirty and over six times more likely to be notified among Indigenous people, respectively.
- Newly acquired hepatitis B and newly diagnosed hepatitis C are 3 times more likely to be notified among Indigenous Australians than non-Indigenous Australians.
- Notification for STIs is particularly high among Indigenous people aged 15-29 years.
- Indigenous Australians living in remote and very remote areas have reported significantly higher rates of several STIs compared to those in urban and regional areas. Reasons for this disparity include lack of accessibility to services as well as the quality of the sexual health care services provided, particularly in rural and remote regions of Australia.
Dr Nattabi led the development of the Sexual Health tool and accompanying protocol.
The purpose of the tool is to enable primary health care services which deliver care to Indigenous Australians to apply state of the art continuous quality improvement (CQI) methods to ensure their clients receive high quality sexual health care. The tool was developed in collaboration with representatives from Indigenous health services and institutions, doctors, nurses, sexual health physicians, rural-based nurses, researchers from key universities across Australia, and quality improvement practitioners. They have a high level of knowledge and practical experience in Indigenous sexual healthcare, are familiar with best practice guidelines and emerging evidence, and expertise in the practical application of audit tools within the ABCD quality improvement system.
To develop the tool, these experts reviewed the guidelines for screening and management of STIs from all the states and territories, other One21seventy tools and sexual health quality improvement literature in order to develop a final list of indicators that were to be included in the tool. The audit tool and protocol thus reflect the current evidence base and best practice for Indigenous primary sexual healthcare. Now completed, the tool is available to over 200 Indigenous primary health care services, through One21seventy, for translation into routine primary sexual healthcare quality improvement practice.
Current research seeks to evaluate the uptake and impact of a sexual health clinical audit tool on quality of care, and to identify successful strategies for improvement of the current sexual health care delivery provided by Aboriginal and Torres Strait Islander primary health care services. Particularly Dr Nattabi is interested in using the revised Promoting Action on Research Implementation in Health Services (PARIHS) framework to determine facilitators and barriers to the uptake of this tool at over 200 Indigenous primary care services across Australia in order to develop and implement evidence-based strategies to enhance uptake of the tool and ultimately reduce the transmission of STIs among the Indigenous population.
Researcher: Dr Barbara Nattabi