DATE FOR DIARY 28 September 2017 IMMUNISATION WORKSHOP National Cervical Screening Programme - Smear taker update – Waikato DHB May 2017 Clare Coles, Manager NCSP, Waikato DHB Acknowledging Robyn Blue, Senior Portfolio Manager, NCSP, MoH DATE FOR DIARY 28 September 2017 IMMUNISATION WORKSHOP Kia ora koutou, my name is Clare Coles. I work in the National Cervical Screening Programme here in Hamilton.

Coverage + recall Coverage is defined as having had a cervical smear within the last 3 years Start recalling women at least 4 weeks before the test is due (more in priority group women, and with women with a history of not responding) Women who don’t respond to recall should not be archived from the recall list Phone call after hours Provide information on options for screening Place an alert on the PMS for opportunistic screening Undertake regular audits to identify women who are unscreened or overdue Most women delay coming in for a cervical smear, so recall should start from at least 4 weeks before the smear is due (recommend this is longer, as most women delay coming for a smear).

National coverage by DHB % Coverage for women 25–69 years: 3 years ending 31 December 2016 One of the main performance measures of NCSP is coverage. This is the percentage of the population who are up to date with their cervical screening. We need as many women as possible in the population to have had a cervical smear in the last 3 years for the programme to be successful. This graph shows the % of women in each DHB region aged 25–69 years who had a smear in the three years ending December 2016. Our target is to reach 80 percent screening coverage for all eligible women, for all ethnicities. As you can see from the graph DHBs with total coverage at 80% or higher are: BOPDHB (81%) Taranaki (80.8%) Nelson Marlborough (80.6%) Total coverage in Waikato is 77.1%. National 76.1 However as we will see in the next graph, national coverage in the three priority groups (Maori, Pacific and Asian) is lower and has the effect of bringing the overall coverage down.

National coverage by DHB - Māori Coverage (%) women 25–69 years, three years ending 31 December 2016 Improvements in Maori coverage are needed (Waikato = 66.3%)….. NZ 66.6 What can you do to assist?

National coverage by DHB - Pacific Coverage (%) women 25–69 years, three years ending 31 December 2016 Improvements in Pacific is better than Maori coverage (Waikato = 78.9%). NZ 76.5

National coverage by DHB – Asian Coverage (%) women 25–69 years, three years ending 31 December 2016 Improvements in Asian coverage are needed nationally (Waikato = 66.3%) NZ 63.7….. What can you do to assist? Note in the next slide that it is coverage in Asian women aged 25-29 years that is pulling this coverage down.

Waikato DHB coverage by ethnicity 31 December 2016 2007 Ten Years ago – Maori was 48%, PI 47%, Asian 51% and Other 81% In Waikato DHB, in the last 3 years there have been incremental changes in improving screening coverage in priority groups – with improvements in Asian coverage. Asian coverage increased from 62.8 to 65.4% (2.6%) – well done Maori coverage increased from 64.7 to 66.3% (1.6%) Pacific coverage increased from 78.2 to 78.9 (0.7%) – This is nearly at 80% well done! Other coverage has remained the same at 81.9% Note that it is possible to improve coverage ‘big time’ in a 3 year period. In CMDHB Pacific coverage increased from 78.5% to 82.2% in the last 3 years.

How many additional women in Waikato DHB would have needed a cervical cytology sample to reach 80% coverage at 31 December 2016? When we break this down further, we can start to put faces to that space under the line. This is how many women need to have a smear for the region to meet the 80% coverage target. If you were to break it down further to how many women need a smear per practice, or how many extra women each of you need to smear, then it starts to become a manageable number. Good luck!

2905 women An average of 36 women per practice Less than 1 per week!

National Policy and Quality Standards (NPQS) Competencies for Cervical Screening Education and Training Section 3 – Cervical Screening Services

Areas in the NPQS document that are useful to review Information on obtaining the optimal cervical sample In most instances the cervibroom is all you will need. Both a cervibroom and a cytobrush can be used if the previous sample was inadequate. Advice on screening in pregnancy Appendices Sample recall letters to be used by practices Template for individual assessment for cervical screening and cervical screening peer review

Important documents for sample takers Guidelines for Cervical Screening in NZ Management of women with an abnormal cervical smear National Policy and Quality Standards (NPQS) Section 3 – Cervical Screening Services

NPQS – Cervical Screening Chapter 2 – Supportive service delivery Cultural competency Support for priority group women Removing barriers to cervical screening Attention to the cervical screening environment and interpersonal factors

Key points All health professionals are required to practice in a culturally-competent way.

Cultural competency Broad view of culture Cultural practices are not restricted to ethnicity Includes religion and spiritual beliefs, sexual orientation, lifestyle, socio-economic status Smear takers need to: be committed to providing quality cervical screening services to people from different cultures and walks of life. maximising access to, and the participation of priority group women in cervical screening. Being supportive and non-judgemental Broad view of culture: Cultural practices are not restricted to ethnicity, but also include gender, beliefs, including spiritual beliefs, sexual orientation, lifestyle, age, social status, socio-economic status. Eg You can have a gang culture, there is a gay culture etc (without stereotyping people).

Support for priority group women Priority group women definition Māori Pacific Asian Women who are unscreened Women who are under-screened (5 years since last smear) $50 $75 2015/16 685 62 2016/17 YTD 1074 79

Using a recent report There were this many Significantly Overdue Priority women in the Waikato Hauraki                                  3,955 PMHN                                   6,237 NHC                                           224 Total       10,416

Provide a space that feels safe, and is private and warm The smear taker partners with women to individualise their care according to each woman’s needs and provides care that respects the woman’s dignity, privacy and autonomy Provide a space that feels safe, and is private and warm Warm blanket Dimming the lights

PHO Cervical Screening Data Match Report This has replaced the paper-based smear taker recall report The paper-based reports are available on request Difference – it includes the screening status of ALL women in the practice: Women screened elsewhere 20+ years old who need to be invited to have a cervical smear all women showing as overdue in the Register cf the ST and OCS paper reports where women overdue would drop off after 90 days Does need some ‘cleaning up’ (depends whether or not the practice actively used the paper reports and advised the NCSP of women no longer needing screening (eg women with a hysterectomy) Able to be filtered to identify women most overdue, and at highest risk The Data match is no different

Karo Practice Cervical Screening Analysis CX Smear Due (both) Eligible + due patients in both the PMS and the NSU lists. CX Smear Due NSU not PMS Eligible + due patients in NCSP-R but are not showing as due in the PMS. ? Women with a hysterectomy for benign reasons – need ‘tracking’ to be turned off in the Register. CX Smear Due PMS not NSU Eligible + due patients in the PMS but are not showing as due in NCSP-R.? A recall issue Exempt Mismatches Exempt status in NSU does not match the exempt status in the PMS - you will need to look closely at these to resolve the difference. Hauraki PHO – The list is in order by date of last consultation with the patient with the most recent visit first.

Any questions? Contact Cindy Tawa or Karen Stockman 0800 729 729

And finally…… This is my last smeartaker update......