1 Cervical screening

1.1 Cervical screening benefits

Regular cervical cancer screening reduces the risk of cancer incidence by approximately a factor of 3 to 4 compared to no screening (for women aged 35 to 79 years), and reduces mortality by a factor of 4 to 10. Regular cervical cancer screening reduces the risk of cervical cancer incidence and death by up to a factor of two compared to irregular cervical cancer screening (Landy et al., 2016).

1.2 Extent of under-screening

According to Practice Incentive program data (May 2018), 61.14% of eligible patients at coHealth Kensington were screened appropriately for cervical cancer.

Using SQL searches in the Best Practice database, as of 1st March 2019 there were 857 eligible patients who were active in seeing the clinic. Of those, 290 patients (34%) had either no recording of a cervical screening, or no cervical screening recording for the previous forty-five months. At the time of writing, cervical screening done forty-five (45) or more months previously would be the ‘Pap’ smear, which needs to be repeated in twenty-four (24) months.

Note : For the purpose of this document, ‘eligible’ patients are females aged between 25 and 75 years, who are not otherwise marked as not requiring future cervical screening. ‘Active’ patients refers to patients who have had three or more contacts with the clinic in the previous two years, including at least once in the previous six months. If the information is available (as it was in March 2019, but not in preceding years), the ‘previous six months’ contact is a ‘billed visit’.

1.2.1 Rate of cervical screening in patients who are underscreened

The number of active and eligible patients who either had no history of screening or were very overdue (more than 45 months old screen, when screening is due every 24 months) as of 1st March 2018 was 270 patients.

Over the next three months, fourteen of those patients (5.2%) had a recorded cervical screening.

In the next three months after that, an additional ten patients (3.7%) had a recorded cervical screening.

SQL search code used to count historical screening found at the end of this document. Note that no billing information is available prior to June 2018, so the definition of an ‘active’ patient is slightly different.

1.3 Usual strategies to promote cervical screening.

During visits for other purposes in a primary care clinic, patients are, where possible, recommended to have cervical screening. This can be aided by automated ‘real-time’ tools such as Doctor’s Control Panel, and the availability of a womens’ health nurse who is available to do cervical screening.

In addition, the clinic runs a reminder system which invites patients to repeat the cervical screening when the next screening is due. This is done with a letter, in English. The government also uses letters to remind people when the next cervical screening is due. Until very recenty, the ‘reminder’ interval has been two years, as cervical screening was done with the ‘Pap’ test until 2018.

1.4 Cervical screening outcome payment

Not available from latter half of 2019.

Current eligible practice population : 754 (according to May 2018 PIP data)

Annual outcome payment : $3 per eligible patient = $2262. Never yet received

  • Current cervical screening coverage rate (according to 2017 PIP data) = 61.14%
  • Target Diabetes SIP claim rate to claim annual outcome payment = 70%

Potential additional Cervical SIP revenue, if target Cervical SIP claim rate achieved, assuming that half of additionally screened women can have a cervical SIP item claimed = (70-61.14)/100 * 754 * $35 * 0.5 = $1169.1

Additional revenue if Cervical Outcome Payment achieved = $2262 (annual outcome payment) + $1169.1 (additional cervical SIP revenue) = $3431.1