Innovative approach increases cervical screening numbers

The Fono included a $10 per patient payment for smear taker nurses for every unscreened or overdue woman they screened at their Henderson clinic once they exceeded 20 smears per month.

The Fono, which is an affiliation between West Fono Health Trust, Pasifika Horizon Healthcare and The Peoples Centre Trust, delivers health services to around 15,000 Pacific and high-needs people across Auckland.

Senior Manager Services Sally Dalhousie says 573 patients of its Henderson clinic were unscreened or overdue for their cervical smears at the beginning of 2014, a large number of whom were priority women.

She says there was recognition by both community services and clinical staff that a concerted, collaborative effort was needed to improve the situation.

While The Fono took a whole-of-practice approach, the initiative was predominantly led by the clinic’s smear taker nurses rather than the GPs. Health care assistant Aivi Puloka drove the project by cleaning up and updating patient data and encouraging the nurse smear takers to be opportunistic about smear taking when seeing patients.

‘One of the challenges of a practice like ours is that our patients tend to have complex and high needs and, unfortunately, cervical screening can be at the bottom of the list of all the things a nurse or GP needs to cover with them in a 15-minute consultation,’ says Sally.

The incentive payment initiative was extended from an initial three-month period to five months. Five hundred of the women who were unscreened or overdue were screened over the period.

Sally says the initiative’s success means an incentive payment may well be part of an overall strategy to improve The Fono’s screening rates in the future.

‘We have four clinics across Auckland and we’re looking at supporting our other clinics to do something similar, although their numbers of overdue smears are much lower.’

‘We’re also looking at other strategies to improve our cervical screening rates and ensure that regular cervical screening becomes business-as-usual for our patients and staff.’