Nurses report 2016

EVALUATION OF CERVICAL SCREENING TESTS COLLECTED BY NURSES IN VICTORIA DURING 2016 Victorian Cervical Cytology Registry

Produced by:

Karen Peasley, Health Information Manager Victorian Cervical Cytology Registry PO Box 161 Carlton South VIC 3053 ISSN 2205-8710 Q-Pulse reference CSR-Pub-1 Telephone: Fax: E-mail:

03 8417 6843 03 9349 1818 data@vcs.org.au

August 2017

The Victorian Cervical Cytology Registry acknowledges the support of the Victorian Government

EVALUATION OF CERVICAL SCREENING TESTS COLLECTED BY NURSES IN VICTORIA DURING 2016 Victorian Cervical Cytology Registry

Produced by:

Karen Peasley, Health Information Manager Victorian Cervical Cytology Registry PO Box 161 Carlton South VIC 3053 ISSN 2205-8710 Q-Pulse reference CSR-Pub-1 Telephone: Fax: E-mail:

03 8417 6843 03 9349 1818 data@vcs.org.au

August 2017

The Victorian Cervical Cytology Registry acknowledges the support of the Victorian Government

Table of Contents Foreword ......................................................................................................................................1 1. Number of Cervical Screening Tests (CST) collected by nurses .............................................2 2. Post-hysterectomy tests ..........................................................................................................3 3. Type of practice/organisation for nurses ..................................................................................4 4. Practice and woman location at time of CST ...........................................................................5 5. Proportion of CST collected by nurses by Department of Health and Human Services (DHHS) area ........................................................................................................................................6 6. Socio-Economic Index for Areas (SEIFA) ................................................................................7 7. Age distribution of CST ............................................................................................................9 8. Endocervical status ...............................................................................................................10 9. Profile of CST ........................................................................................................................11 10. Time since previous screening ............................................................................................12 11. Collection of Aboriginal and Torres Strait Islander status, Country of Birth and Language Spoken at Home ...................................................................................................................13 12. Conclusion ...........................................................................................................................16 13. References ..........................................................................................................................17

Tables and Figures Table 1.1

Number of Cervical Screening Tests (CST) collected by nurses in Victoria by year of collection………………………………………………………………………….……….......

3

Figure 1.1

Proportion of CST collected by nurses in Victoria, 1996-2016...………………….………

3

Table 3.1

Number of CST collected by nurses during 2016 by practice/organisation type..............

4

Figure 3.1

Comparison of the proportion of CST collected by nurses 2014 to 2016 by practice/organisation type..............................................................................................

4

Nurse practice and CST location in 2016 by Australian Statistical Geography Standard Remoteness Areas, Victoria……………………..............................................................

5

CST for women with a cervix collected by nurses by Department of Health and Human Services (DHHS) area, Victoria, 2016…………………………………………….…..........

6

Figure 5.1

Proportion of CST collected by nurses during 2016 by DHHS area....………….....…….

7

Table 6.1

Distribution of women screened by nurses in Victoria by SEIFA category during 2015 and 2016…………………...…………………………………………………………………..

8

Figure 6.1

SEIFA distribution of women screened by nurses in Victoria during 2015 and 2016…...

8

Table 7.1

Age distribution at time of CST in 2015 and 2016………………….………………………

9

Figure 7.1

Age distribution at time of CST in 2016..........................................................................

9

Figure 8.1

Proportion of Victorian Pap tests collected by nurses and other provider types with an endocervical component, 2002-2016……......................................................................

10

Table 9.1

Profile of Pap test results collected during 2016 for women with a cervix…...……..........

11

Table 9.2

Profile of HPV (without LBC) test results for women during 2016…………..…………….

11

Table 10.1

Time since previous CST during 2016 for women with a cervix…….…...………………..

12

Table 11.1

Number and percentage of CST collected by nurses in 2016 by Aboriginal and Torres Strait Islander status ………………….……………..……………………………………….

13

Percentage of CST collected by nurses for which Aboriginal and Torres Strait Islander status, Language Spoken at Home and Country of Birth were recorded for each month of 2016……………………………………………………………………………...................

14

Percentage of CST collected by nurses for which Aboriginal and Torres Strait Islander status, Language Spoken at Home and Country of Birth were recorded by year ………………………………………………………………………………………..…………

15

Table 4.1 Table 5.1

Figure 11.1

Figure 11.2

Foreword Victorian Nurse Cervical Screening Providers - Credentialling Program 2016 The 2016 Victorian Cervical Cytology Registry (VCCR) Nurses Evaluation Report highlights the cervical screening of Victorian nurses in the 20th year of the credentialling program. The program continues its role in monitoring cervical screening nurse providers through ongoing quality assurance, professional accountability and responsibility for clinical practice.

Nurses who completed their endorsed Victorian training course in 2016, were granted a one year credentialling period to enable supportive quality monitoring after their first year of practice.

Thereafter these nurses would be approved for a three year re-credentialling period. The credentialling process ensures Victorian women continue to receive a high quality of service in cervical screening, and that nurses are equipped with up-to-date knowledge on screening practices and technologies.

In 2016, the program had 466 registered nurses, 429 of whom were actively participating in the screening program.

The quality of nurses’ practice has been reported by the VCCR annually since 2000. Throughout Australia only Victoria has nurse collected cervical screening data reported by their cervical cytology registry.

The 2016 VCCR Nurses Evaluation Report is the fourth edition in which data from all Victorian nurses providing cervical screening has been reported, regardless of pathology provider used.

The outcome of this report demonstrates the close working relationship between VCCR and PapScreen Victoria (PSV) and their shared commitment to showcasing cervical screening undertaken by Victorian nurse cervical screening providers.

We would like to acknowledge the work of VCCR, VCS Pathology and PapScreen Victoria staff who have enabled the successful reporting of cervical screening provided by nurses working in Victoria.

Sandy Anderson Victorian Nurse Cervical Screening Credentialling Coordinator and Nurse Consultant Screening, Early Detection and Immunisation Cancer Council Victoria Sadya Anjum and Alexandra McNaughton Credentialling Secretariat and Project Support Officer Screening, Early Detection and Immunisation Cancer Council Victoria Phone: 1800 111 255 Email: certification@cancervic.org.au

1

1. Number of Cervical Screening Tests (CST) collected by nurses

This report includes data on Cervical Screening Tests (CST) where nurses are credentialled and funded by the Department of Health and Human Services (DHHS) to be eligible for their own ‘practice number’ at VCS Pathology. Also included in this report are CST from nurses using Private Pathology Services. These nurses provide cervical screening data to PapScreen Victoria, which is then provided to the Victorian Cervical Cytology Registry (VCCR) for analysis in this report.

The report captures all CST reported in Victoria, including those conducted as part of the Compass study. The Compass study is a clinical trial comparing two and a half yearly Pap test screening with five yearly Human Papillomavirus (HPV) screening.1 The Pilot study commenced at the end of 2013 and the Main trial commenced at the start of 2015. Since 2014, data from the study has been included in this report.

Data in this report include: 1. All Pap and LBC2 tests (as usually reported) that are not part of Compass 2. All LBC primary screening tests conducted as part of Compass 3. LBC triage tests for Compass 4. Compass HPV primary screening tests for which there is no LBC triage As reported to the VCCR, a total of 31,574 CST were collected by 429 nurses during 2016 (with 31,303 from women with a cervix). This is out of a total of 585,554 Victorian CST for 2016 (with 577,155 from women with a cervix).

Of the CST reported by nurses, 27,520 tests (87.2%) were reported to VCS Pathology. The remaining 4,054 tests (12.8%) were taken by nurses and reported by Private Pathology Services under a doctor's name.

The 31,574 tests collected by nurses represents 5.4% of all Victorian CST collected during 2016. As shown in Table 1.1 and Figure 1.1, the number and proportion of tests collected by nurses has decreased compared to the previous two years (2014 and 2015). However the number remains more than six times higher than the figure recorded in 1996.

1 2

Victorian Cytology Service (VCS). Compass Future Directions in Cervical Screening. URL: http://www.compasstrial.org.au Accessed: 28/08/2017 Liquid Based Cytology

2

Table 1.1 Number of Cervical Screening Tests (CST) collected by nurses in Victoria by year of collection3 Number of CST collected by nurses 31,574 33,780 36,4104 38,012 33,875 31,613 28,546 25,594 21,668 18,651 16,035 14,375 13,100 11,494 10,635 11,017 9,628 9,922 9,858 7,155 5,170

Year 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996

% of all Victorian CST 5.4% 5.6% 6.1% 6.3% 5.6% 5.5% 5.0% 4.4% 3.8% 3.2% 2.8% 2.5% 2.2% 2.0% 1.8% 1.9% 1.7% 1.6% 1.6% 1.2% 0.8%

Figure 1.1 Proportion of CST collected by nurses in Victoria, 1996 – 2016 7% 6%

PERCENTAGE

5% 4% 3% 2% 1%

2016

2015

2014

2013

2012

2011

2010

2009

2008

2007

2006

2005

2004

2003

2002

2001

2000

1999

1998

1997

1996

0%

YEAR

2. Post-hysterectomy tests 271 CST collected by nurses during 2016 were taken from women whose records indicate they have had a hysterectomy. This represents 0.9% of tests collected by nurses in 2016. The percentage of post-hysterectomy tests completed by other Victorian provider types in 2016 was 0.7%.

3 4

Data from 1996-2012 excludes tests taken by nurses through Private Pathology under a doctor’s name Since 2014, HPV tests (without LBC) and Pap tests completed by nurses as part of the Compass trial have been included in these data

3

3. Type of practice/organisation for nurses Of the CST collected by nurses during 2016, the majority were conducted in General Practice or in a Community Health setting. The combined proportion of CST collected in General Practice or a Community Health setting has fallen slightly to 87.1% in 2016 from 88.0% in 2015. There was a small increase in collection by Other services (eg: hospitals and dysplasia clinics), Private Pathology Service and Aboriginal Health Service practice types between 2015 and 2016.

Table 3.1 Number of CST collected by nurses during 2016 by practice/organisation type Number of practices/ organisations

Number of nurses practicing5

Number of CST by nurses during 2016

% of CST by practice/ organisation

General Practice

234

245

20,253

64.1%

Community Health setting

86

92

7,263

23.0%

Women’s Health Service6

1

2

243

0.8%

Sexual Health7

3

38

788

2.5%

Other (eg: hospitals and dysplasia clinics)

21

34

1,774

5.6%

Private Pathology Service

2

2

978

3.1%

Aboriginal Health Service8

11

16

275

0.9%

Total

358

429

31,574

100.0%

Practice/organisation type

Figure 3.1 Comparison of the proportion of CST collected by nurses 2014 to 2016 by practice/organisation type 70% 60%

PERCENTAGE

50% 40% 2014

30%

2015 2016

20% 10% 0% General Practice

Community Health Setting

Women’s Health Service

Sexual Health

Other (eg: hospital and dysplasia clinics)

Private Pathology Service

Aboriginal Health Service

PRACTICE/ORGANISATION TYPE

5

For nurses who worked at more than one type of practice/organisation, their most common type was used Women’s Health Service represent state wide health services such as Women’s Health Loddon Mallee Sexual Health includes: Melbourne Sexual Health Centre, Family Planning Victoria – Box Hill, and the Action Centre – Family Planning Victoria 8 Prior to 2014, data identified as CST in Aboriginal Health Services was categorised in the other listed practice types 6 7

4

4. Practice and woman location at time of CST During 2016, 429 nurses performed CST in Victoria. The Registry recorded 394 credentialled nurses whose tests were reported by VCS Pathology. PapScreen Victoria provided the details of 35 additional unique nurses whose CST were reported to the Registry through Private Pathology Services under a doctor’s name.

The geographical location of nurses (by practice) and the women whose CST were collected by a nurse during 2016 are classified below using the Australian Statistical Geography Standard (ASGS) Remoteness Areas.

The ASGS Remoteness Areas classification was developed by the Australian Bureau of Statistics (ABS), and classifies areas of Australia which share common characteristics of remoteness into broad geographical regions.

The ASGS Remoteness Areas classification divides Australia into five areas:9 • Major Cities of Australia: includes capital cities such as Melbourne, as well as major urban areas such as Geelong • Inner Regional Australia: includes towns such as Ballarat, Bendigo and Shepparton • Outer Regional Australia: includes towns and cities such as Bairnsdale and Horsham • Remote Australia: includes towns such as Mallacoota and Ouyen • Very Remote Australia: represents much of central and western Australia and includes towns such as Tennant Creek, Longreach and Coober Pedy Using the ASGS classification, Table 4.1 shows that the majority of nurses who collected CST during 2016 were based in a major city or inner regional area, as were the women tested.

Table 4.1 Nurse practice and CST location in 2016 by Australian Statistical Geography Standard Remoteness Areas, Victoria10 ASGS Remoteness Area

Nurses located in the area

CST in the area11

Number

%

Number

%

Major Cities of Australia

207

48.2

13,757

43.6

Inner Regional Australia

167

38.9

12,717

40.3

Outer Regional Australia

55

12.9

4,957

15.8

Remote Australia

0

0.0

95

0.3

Very Remote Australia12

0

0.0

0

0.0

9

Australian Bureau of Statistics (2011). Australian Statistical Geography Standard (ASGS): Volume 5, Remoteness Structure July 2011. Cat. no.1270.0.55.005. URL: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1270.0.55.005Main+Features1July%202011?OpenDocument Courtesy of the Australian Institute of Health and Welfare (AIHW) (May 2014). Postal Area to ASGS RA conversion file. Data is based on 2011 Remoteness Areas on 2011 census data 11 The postcodes for 48 CST could not be mapped as there was no postcode recorded 12 Very Remote Australia areas are not represented within Victoria 10

5

5. Proportion of CST collected by nurses by Department of Health and Human Services (DHHS) area The Victorian DHHS operates across the state from within seventeen local areas, of which nine are in rural Victoria and eight in metropolitan Melbourne. The DHHS regions and areas have changed since the production of the 2015 report so, for comparison purposes, 2015 data were re-calculated using the revised DHHS areas. The table and map below show that nurses collected a higher proportion of CST in rural areas than in metropolitan areas. The proportion of CST collected by nurses increased marginally in the Brimbank Melton and Western District areas between 2015 and 2016.

Table 5.1 CST for women with a cervix collected by nurses by Department of Health and Human Services (DHHS) area, Victoria, 201613 Number of CST collected by nurses in 201614

Number of nurses in each area in 201615

% of all CST per area collected by nurses in 2016

% of all CST per area collected by nurses in 2015

Barwon

2,152

27

8.0%

8.8%

Bayside Peninsula

1,387

18

1.5%

1.8%

Brimbank Melton

1,450

12

5.2%

4.9%

Central Highlands

2,035

23

12.9%

15.5%

Goulburn

1,373

27

10.9%

12.3%

Hume Moreland

1,154

11

3.6%

4.2%

927

23

1.5%

1.7%

Inner Gippsland

1,064

14

6.8%

7.9%

Loddon

3,445

45

16.8%

18.0%

Mallee

2,162

25

29.6%

32.7%

North Eastern Melbourne

1,522

27

2.4%

2.5%

Outer Eastern Melbourne

1,261

19

3.2%

3.8%

Outer Gippsland

1,197

12

16.7%

17.2%

Ovens Murray

2,286

24

20.7%

23.4%

Southern Melbourne

1,926

17

4.2%

4.1%

Western District

2,301

27

18.5%

18.2%

Western Melbourne

3,097

69

5.4%

5.4%

Area name

Inner Eastern Melbourne

13

Department of Health and Human Services LGA by Area Region Division concordance file supplied 10/8/2017 Australian Bureau of Statistics (2011). Australian Statistical Geography Standard (ASGS): Correspondences July 2011. Cat. no.1270.0.55.006.

Postcode 2011 to LGA 2011 Accessed 10/8/2017 URL: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1270.0.55.006Main+Features1July%202011?OpenDocument 14 Excludes 271 post-hysterectomy CST, 565 CST with interstate postcodes or unable to be mapped 15 Excludes 11 nurses with interstate postcodes

6

Figure 5.1 Proportion of CST collected by nurses during 2016 by DHHS area

6. Socio-Economic Index for Areas (SEIFA) Socio-Economic Index for Areas (SEIFA) 2011 is a summary measure developed by the Australian Bureau of Statistics (ABS), which includes four indexes to allow the ranking of regions, to then determine the level of social and economic well-being in that region.16 This report uses the Index of Relative Socio-economic Disadvantage (IRSD), which is a general measure focusing on disadvantage. The IRSD is derived from attributes such as income, education level, unemployment, disability, and dwellings without internet connection. In particular it focuses on low income earners, relatively lower educational attainment and high unemployment.17 Index of disadvantage scores have been grouped into quintiles (1 to 5) for analysis. The highest quintile (5) represents the highest 20% of postcode scores (20% of the population) and includes the least disadvantaged areas. The lowest quintile (1) represents the lowest scores and the most disadvantaged areas.

As seen in both the table and figure, most women (over 60%) screened by nurses during 2015 and 2016 are categorised in the most disadvantaged quintiles (1 and 2).

16 17

SEIFA 2011 was released 28/03/2013 and is based on 2011 social and economic Census data Australian Bureau of Statistics (2013). IRSD. URL: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/2033.0.55.001main+features100052011.

Accessed: 28/08/2017

7

Table 6.1 Distribution of women screened by nurses in Victoria by SEIFA category during 2015 and 201618

Number of women19 10,233

2015 Percentage of nurse screened women 35.0%

Number of women20 10,406

2016 Percentage of nurse screened women 33.6%

2

7,613

26.0%

8,612

27.8%

3

4,613

15.8%

5,091

16.4%

4

5,045

17.3%

5,208

16.8%

5 (least disadvantaged)

1,719

5.9%

1,682

5.4%

Quintile 1 (most disadvantaged)

Figure 6.1 SEIFA distribution of women screened by nurses in Victoria during 2015 and 201621

40% 2015 35% 2016

PERCENTAGE

30% 25% 20% 15% 10% 5% 0% 1 (most disadvantaged)

2

3

4

5 (least disadvantaged)

QUINTILE

18

Australian Bureau of Statistics (2011) Census of Population and Housing: Socio-Economic Indexes for Areas 2011, Postal Area IRSD, SEIFA 2011 Cat. no. 2033.0.55.001. Accessed: 28/08/2017 URL: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/2033.0.55.0012011?OpenDocument 19 333 women could not be aggregated into SEIFA quintiles as there was no postcode to Postal Area match in the concordance file (57), the postcode was blank (44) or the postcode was interstate (232). NB: SEIFA calculations are based on women with a Victorian postcode only.

20 575 women could not be aggregated into SEIFA quintiles as there was no postcode to Postal Area match in the concordance file (69), the postcode was blank (9) or the postcode was interstate (497). NB: SEIFA calculations are based on women with a Victorian postcode only.

21 The SEIFA data provided in Table 6.1 and Figure 6.1 of the ‘Evaluation of Cervical Screening Tests collected by Nurses in Victoria during 2015’ report was found to have errors and so has been reproduced in the 2016 report.

8

7. Age distribution of CST The age distribution of women whose CST were collected by nurses and other provider types is shown in the table below.22 23 Other provider types include GPs, obstetrician and gynaecologists and hospital clinics. A comparison of 2015 and 2016 data shows the percentage of CST for each age group to be similar for both nurses and other provider types.

Consistent with the findings for 2015, the aggregated percentage of CST collected by nurses during 2016 for women aged 50 years or older was greater than those collected by other provider types (43.1% compared with 33.4%).

Table 7.1 Age distribution at time of CST in 2015 and 201624 CST collected by: Age group

Nurses 2015

2016

Other Provider types 2015 2016

<20 yrs

1.2%

1.1%

1.3%

1.2%

20-29 yrs

15.7%

15.2%

19.2%

18.8%

30-39 yrs

18.6%

18.8%

23.7%

24.3%

40-49 yrs

22.0%

21.8%

22.6%

22.3%

50-59 yrs

21.7%

22.0%

18.8%

18.7%

60-69 yrs

19.3%

19.4%

12.9%

13.1%

70+ yrs

1.5%

1.7%

1.5%

1.6%

Total

100%

100%

100%

100%

Figure 7.1 Age distribution at time of CST in 2016 30%

% CST collected by nurses 24.3%

25%

% CST collected by other providers

21.8% 22.3% 22.0%

PERCENTAGE

20%

18.8%

18.8%

18.7%

19.4%

15.2%

15%

13.1%

10%

5% 1.1%

1.7%

1.2%

1.6%

0% < 20 yrs

20-29 yrs

30-39 yrs

40-49 yrs

50-59 yrs

60-69 yrs

70+ yrs

AGE GROUP

22 23 24

Age range for Compass trial participants is 25-64 years Analysis is based on the number of tests, not the number of women For the 2015 and 2016 data there were 47 tests and 25 tests respectively which were excluded where the woman DOB was not provided

9

8. Endocervical status The presence of endocervical cells within a Pap test specimen is considered to be a reflection of smear quality. Of the technically satisfactory Pap tests collected from women with a cervix by nurses in 2016, 74.1% were reported as including an endocervical component. The proportion of Pap tests with an endocervical component for other provider types during the same time period was 69.8%.

The graph below shows that the proportion of Pap tests collected by nurses having an endocervical component remained stable between 2013 and 2014, with a decline during 2015 followed by a slight increase in 2016. The proportion for other provider types has continued to decrease during 2016.

Over the decade prior to 2013, a general decline in the proportion of Pap tests with an endocervical component has been observed across all provider types.

Figure 8.1 Proportion of Victorian Pap tests collected by nurses and other provider types with an endocervical component, 2002-201625

86% 84% 82%

PERCENTAGE

80% 78% 76% Nurses 74%

Other provider types

72% 70% 68% 66%

YEAR

25

Excludes Compass HPV tests (without LBC)

10

9. Profile of CST The following tables show the result categories for CST collected by nurses and other provider types during 2016. Note that Pap tests and HPV (without LBC) tests are shown in separate tables.

Table 9.1 shows the Pap test result categories for tests collected by nurses and other provider types during 2016 for women with a cervix. Compared with Victorian Pap tests collected by other provider types, nurses had a significantly higher proportion of tests with negative results (p<0.0001) and significantly lower proportions with high-grade results (p=0.002) and unsatisfactory tests (p<0.0001).

Table 9.1 Profile of Pap test results collected during 2016 for women with a cervix26 Result category27

Number (%) of Pap tests collected by nurses

% of Pap tests collected by other provider types

High-grade abnormality

152

(0.5%)

0.7%

Low-grade abnormality

1,144

(4.0%)

4.4%

164

(0.6%)

0.6%

26,604

(93%)

91.5%

516

(1.8%)

2.8%

12

(0.1%)

-

28,592

(100%)

100%

Inconclusive Negative Unsatisfactory No reported result* Total

*This indicates Pap tests where there were no reported results by nurses using Private Pathology Services

Table 9.2 shows the HPV (without LBC) test result categories for tests collected by nurses during 2016. These results are part of cervical screening completed in the Compass trial. Almost 97% of HPV (without LBC) tests returned a negative result, with the remaining tests returning a positive result (not type 16/18) and two unsatisfactory results. The number of Compass HPV (without LBC) tests completed by nurses during 2016 has shown a slight decrease from the 2015 numbers.

Table 9.2 Profile of HPV (without LBC) test results for women during 201628

Test result Negative Positive (not type 16/18*) Unsatisfactory Total

Number (%) of tests 2629

(96.9%)

80

(2.9%)

2

(<0.1%)

2711

(100%)

*type 16/18 data = 0

26 27 28

Excludes Compass HPV (without LBC) tests and 271 post-hysterectomy CST Based only on the squamous cell code within the VCCR Cytology Coding Schedule 2006 Includes HPV tests (without LBC) completed as part of Compass. It does not represent the total number of Primary HPV tests across both the Pilot and Main trial.

11

10. Time since previous screening The following table shows the length of time since any previous CST, as known to the Registry, for tests collected by nurses during 2016. Compared with CST collected by other Victorian provider types, and similar to the findings of 2015, a higher proportion of CST were collected by nurses where the time interval since the last test was between 21â&#x20AC;&#x201C;27 months.

Table 10.1 Time since previous CST during 2016 for women with a cervix29

Time since previous test

Number (%) of CST collected by nurses30

% of CST collected by other provider types

No previous test

2,896

(9.3%)

11.5%

<21 months

4,414

(14.1%)

22.7%

11,905

(38.0%)

22.7%

Greater than 27 months

6,609

(21.1%)

26.8%

Greater than 36 months

2,474

(7.9%)

7.7%

Greater than 48 months

2,995

(9.6%)

8.5%

10

(<0.1%)

-

31,303

(100%)

100%

21-27 months

Unknown31 Total

29

The number of CST includes Pap tests and both Pap tests and HPV tests completed as part of Compass. It excludes 271 post-hysterectomy CST. Due to the rounding of percentages, there may be some discrepancy in totals 31 Unknown (n=10) represents the data from PapScreen Victoria where time since previous CST for women with a cervix was not reported 30

12

11. Collection of Aboriginal and Torres Strait Islander status, Country of Birth and Language Spoken at Home

The Victorian Cancer Plan 2016-2020 recognises that there are inequities for Aboriginal Victorians across the entire cancer pathway including cancer screening. The plan seeks to achieve equitable cancer outcomes for Aboriginal communities. It is acknowledged that there is now improved cancer screening program participation for under screened groups including Aboriginal communities32,33 For the past eight years, the nurses who work with VCS Pathology have recorded Aboriginal and Torres Strait Islander status on the VCS Pathology Request Forms.

The standard nationally approved format used on data collection forms is as follows: • • • •

Aboriginal Torres Strait Islander Aboriginal and Torres Strait Islander Not Aboriginal or Torres Strait Islander

Table 11.1 Number and percentage of CST collected by nurses in 2016 by Aboriginal and Torres Strait Islander status

2016 Aboriginal and Torres Strait Islander status Aboriginal Torres Strait Islander Aboriginal and Torres Strait Islander Not Aboriginal or Torres Strait Islander Declined to answer Data not collected Total

Number 455

(%)34

2015 %

(1.4%)

1. 4%

(<0.1%)

<0.1%

(0.1%)

0.1%

30,172

(95.6%)

96.0%

1

(<0.1%)

-

(2.8%)

2. 4%

100%

100%

5 43

898 31,574

The overall percentage of CST collected by nurses for which an Aboriginal and Torres Strait Islander status was reported in 2016 was 97.2%, a slight decrease of 0.4% from 97.6% in 2015. The distribution of Aboriginal and Torres Strait Islander status for the women that had a CST collected by nurses has remained consistent between 2015 and 2016.

32

Department of Health and Human Services (2016) Victorian Cancer Plan 2016-2020 Improving cancer outcomes for all Victorians, State Government of Victoria, Melbourne Department of Health and Human Services (2015) Victorian Public Health and Wellbeing Plan 2015-2019, State Government of Victoria, Melbourne 34 Due to rounding of percentages, there may be some discrepancy in totals 33

13

In 2011, data collection was expanded to also include Country of Birth and Language Spoken at Home. The collection of this additional information will continue to assist with understanding and addressing the screening needs of women from culturally diverse backgrounds.

Figure 11.1 Percentage of CST collected by nurses for which Aboriginal and Torres Strait Islander status, Language Spoken at Home and Country of Birth were recorded for each month of 2016

100%

PERCENTAGE

90%

80%

70%

60%

50% JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

2016 Aboriginal and Torres Strait Islander data

Language Spoken data

Country of Birth data

In 2016, the overall percentage of CST recorded by nurses for which Language Spoken at Home was collected was 95.0%. This is a slight increase of 0.4% from 2015.35 The most common NonEnglish languages were as follows (most common first): Vietnamese, Khmer, Chinese (not elsewhere classified), Mandarin, Greek, Italian, Karen, Arabic, Hindi and Cantonese.

The overall percentage of CST recorded by nurses for which Country of Birth was recorded was 96.3%. Again this is a slight increase of 0.4% from 2015.35 The most common countries of birth outside of Australia were as follows (most common first): England, Vietnam, China (excludes SARS and Taiwan), Cambodia, Myanmar, New Zealand, India, United Kingdom (includes Channel Islands and Isle of Man), Philippines and Italy.

35

Due to an internal system issue, the data for Language Spoken at Home and Country of Birth for the period 2011 to 2015 were found to contain errors and have been reviewed and reproduced for this report.

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VCCR continues to work closely with VCS Pathology and Cancer Council Victoria to capture these data items on the registry database from nurse notifications including from nurses who use Private Pathology Services. Figure 11.2 below represents the continued increase in the recording of Aboriginal and Torres Strait Islander status and of Language Spoken at Home and Country of Birth.

The high percentage figures shown illustrate the strong commitment to complete data collection by nurses involved in cervical screening.

Figure 11.2 Percentage of CST collected by nurses for which Aboriginal and Torres Strait Islander status, Language Spoken at Home and Country of Birth were recorded by year36

100% 94.4%

95% 90%

89.8% 87.0%

PERCENTAGE

85% 80% 75%

97.1%

96.6%

94.6%

93.4%

93.3%

97.6% 95.9%

97.2% 96.3%

94.6%

95.0%

2015

2016

91.7%

86.9% 79.4% 77.7%

70% 65% 60% 55% 50% 2011

2012

2013

2014 YEAR

Aboriginal and Torres Strait Islander data

36

Language Spoken data

Country of Birth data

Due to an internal system issue, the data for Language Spoken at Home and Country of Birth for the period 2011 to 2015 were found to contain errors and have been reviewed and reproduced for this report.

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12. Conclusion

There were 429 active credentialled nurses in Victoria during 2016. Of these, 394 reported Cervical Screening Tests (CST) directly to VCS Pathology and the remaining 35 reported to the Registry through other Private Pathology Services under a doctorâ&#x20AC;&#x2122;s name.

During 2016, the number of tests collected by these credentialled nurses and reported to the Registry was 31,574 tests (87.2% reported through VCS Pathology and 12.8% reported through private pathology under a doctorâ&#x20AC;&#x2122;s name). The CST collected by nurses represented 5.4% of all CST performed that year, which was a slight reduction from 5.6% in 2015.

General Practice and Community Health settings continued to represent the main practice/ organisation types where nurses collected CST. There was also a slight increase in collection by other practice types including the Private Pathology, Aboriginal Health Service and Other categories (eg: hospital and dysplasia clinics).

The majority of nurses who collected CST, and Victorian women who had CST collected by nurses, during 2016 were located in major cities or inner regional areas of Victoria.

In 2016, nurses continued to collect a higher proportion of tests from women over the age of 50 years than other provider types. Although a general downward trend has been observed over the last decade, the proportion of Pap tests with an endocervical component continued to be higher for nurses than other provider types during 2016.

The data in this report highlight the important role that nurses have in the success of the Victorian Cervical Screening Program, particularly in relation to the rising number of CST performed by them over the past two decades and the high quality of their tests. Also of note is the commitment of nurses to complete data collection, which assists with identifying under screened groups.

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13. References Australian Bureau of Statistics (ABS) (2011). Australian Statistical Geography Standard (ASGS): Correspondences July 2011. Cat. No.1270.0.55.006. URL: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1270.0.55.006Main+Features1July%202011 ?OpenDocument Australian Bureau of Statistics (ABS) (2011). Australian Statistical Geography Standard (ASGS): Volume 5, Remoteness Structure July 2011. Cat. No.:1270.0.55.005. URL: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1270.0.55.005Main+Features1July%202011 ?OpenDocument Australian Bureau of Statistics (ABS) (2013). Glossary of Statistical Geography Terminology.

Cat. No. 1217.0.55.001. URL: www.abs.gov.au/ausstats/abs@.nsf/mf/1217.0.55.001 Australian Bureau of Statistics (ABS) (2013). Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA) Cat. No. 2033.0.55.001. URL: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/2033.0.55.001Main+Features12011?OpenD ocument Courtesy of the Department of Health and Human Services (DHHS), Health and Wellbeing Division, Screening and Preventative Health Programs, Screening and Cancer Prevention Unit (2016). LGA by DHHS Area Region Division concordance file.

Courtesy of the Australian Institute of Health and Welfare (AIHW) (May 2014). Postal Area to ASGS RA conversion file. Data is based on 2011 Remoteness Areas on 2011 census data.

Department of Health and Human Services (DHHS), Victoria (2016). Victoria's Cancer Plan 20162020. State Government of Victoria, Melbourne. https://www2.health.vic.gov.au/about/health-strategies/cancer-care/victorian-cancer-plan Department of Health and Human Services (DHHS), Victoria (2015). Victorian Public Health and Wellbeing Plan 2015-2019. State Government of Victoria, Melbourne. https://www2.health.vic.gov.au/about/health-strategies/public-health-wellbeing-plan Victorian Cervical Cytology Registry (VCCR) (2006). 2006 Cytology Coding Schedule.

Victorian Cytology Service (VCS). Compass: Future Directions in Cervical Screening. URL: http://www.compasstrial.org.au/main

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