Incomplete recording of Indigenous identification status under-estimates the prevalence of Indigenous population attending Australian general practices

A cross sectional study

Belinda K. Ford, Marlene Kong, James S. Ward, Jane S. Hocking, Christopher K. Fairley, Basil Donovan, Rebecca Lorch, Simone Spark, Matthew Law, John Kaldor, Rebecca Guy

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Australian Aboriginal and Torres Strait Islander (Indigenous) peoples face major health disadvantage across many conditions. Recording of patients' Indigenous status in general practice records supports equitable delivery of effective clinical services. National policy and accreditation standards mandate recording of Indigenous status in patient records, however for a large proportion of general practice patient records it remains incomplete. We assessed the completeness of Indigenous status in general practice patient records, and compared the patient self-reported Indigenous status to general practice medical records. Methods: A cross sectional analysis of Indigenous status recorded at 95 Australian general practices, participating in the Australian Chlamydia Control Effectiveness Pilot (ACCEPt) in 2011. Demographic data were collected from medical records and patient surveys from 16 to 29 year old patients at general practices, and population composition from the 2011 Australian census. General practitioners (GPs) at the same practices were also surveyed. Completeness of Indigenous status in general practice patient records was measured with a 75% benchmark used in accreditation standards. Indigenous population composition from a patient self-reported survey was compared to Indigenous population composition in general practice records, and Australian census data. Results: Indigenous status was complete in 56% (median 60%, IQR 7-81%) of general practice records for 109,970 patients aged 16-29 years, and Indigenous status was complete for 92.5% of the 3355 patients aged 16-29 years who completed the survey at the same clinics. The median proportion per clinic of patients identified as Indigenous was 0.9%, lower than the 1.8% from the patient surveys and the 1.7% in clinic postcodes (ABS). Correlations between the proportion of Indigenous people self-reporting in the patient survey (5.2%) compared to status recorded in all patient records (2.1%) showed a fair association (r = 0.6468; p < 0.01). After excluding unknown /missing data, correlations weakened. Conclusions: Incomplete Indigenous status records may under-estimate the true proportion of Indigenous people attending clinics but have higher association with self-reported status than estimates which exclude missing/unknown data. The reasons for incomplete Indigenous status recording in general practice should be explored so efforts to improve recording can be targeted and strengthened.

Original languageEnglish
Article number567
Number of pages8
JournalBMC Health Services Research
Volume19
Issue number1
DOIs
Publication statusPublished - 14 Aug 2019

Keywords

  • Aboriginal and/or Torres Strait islander people
  • General practice
  • Health data
  • Indigenous status
  • Medical records

Cite this

Ford, Belinda K. ; Kong, Marlene ; Ward, James S. ; Hocking, Jane S. ; Fairley, Christopher K. ; Donovan, Basil ; Lorch, Rebecca ; Spark, Simone ; Law, Matthew ; Kaldor, John ; Guy, Rebecca. / Incomplete recording of Indigenous identification status under-estimates the prevalence of Indigenous population attending Australian general practices : A cross sectional study. In: BMC Health Services Research. 2019 ; Vol. 19, No. 1.
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title = "Incomplete recording of Indigenous identification status under-estimates the prevalence of Indigenous population attending Australian general practices: A cross sectional study",
abstract = "Background: Australian Aboriginal and Torres Strait Islander (Indigenous) peoples face major health disadvantage across many conditions. Recording of patients' Indigenous status in general practice records supports equitable delivery of effective clinical services. National policy and accreditation standards mandate recording of Indigenous status in patient records, however for a large proportion of general practice patient records it remains incomplete. We assessed the completeness of Indigenous status in general practice patient records, and compared the patient self-reported Indigenous status to general practice medical records. Methods: A cross sectional analysis of Indigenous status recorded at 95 Australian general practices, participating in the Australian Chlamydia Control Effectiveness Pilot (ACCEPt) in 2011. Demographic data were collected from medical records and patient surveys from 16 to 29 year old patients at general practices, and population composition from the 2011 Australian census. General practitioners (GPs) at the same practices were also surveyed. Completeness of Indigenous status in general practice patient records was measured with a 75{\%} benchmark used in accreditation standards. Indigenous population composition from a patient self-reported survey was compared to Indigenous population composition in general practice records, and Australian census data. Results: Indigenous status was complete in 56{\%} (median 60{\%}, IQR 7-81{\%}) of general practice records for 109,970 patients aged 16-29 years, and Indigenous status was complete for 92.5{\%} of the 3355 patients aged 16-29 years who completed the survey at the same clinics. The median proportion per clinic of patients identified as Indigenous was 0.9{\%}, lower than the 1.8{\%} from the patient surveys and the 1.7{\%} in clinic postcodes (ABS). Correlations between the proportion of Indigenous people self-reporting in the patient survey (5.2{\%}) compared to status recorded in all patient records (2.1{\%}) showed a fair association (r = 0.6468; p < 0.01). After excluding unknown /missing data, correlations weakened. Conclusions: Incomplete Indigenous status records may under-estimate the true proportion of Indigenous people attending clinics but have higher association with self-reported status than estimates which exclude missing/unknown data. The reasons for incomplete Indigenous status recording in general practice should be explored so efforts to improve recording can be targeted and strengthened.",
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Incomplete recording of Indigenous identification status under-estimates the prevalence of Indigenous population attending Australian general practices : A cross sectional study. / Ford, Belinda K.; Kong, Marlene; Ward, James S.; Hocking, Jane S.; Fairley, Christopher K.; Donovan, Basil; Lorch, Rebecca; Spark, Simone; Law, Matthew; Kaldor, John; Guy, Rebecca.

In: BMC Health Services Research, Vol. 19, No. 1, 567, 14.08.2019.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Incomplete recording of Indigenous identification status under-estimates the prevalence of Indigenous population attending Australian general practices

T2 - A cross sectional study

AU - Ford, Belinda K.

AU - Kong, Marlene

AU - Ward, James S.

AU - Hocking, Jane S.

AU - Fairley, Christopher K.

AU - Donovan, Basil

AU - Lorch, Rebecca

AU - Spark, Simone

AU - Law, Matthew

AU - Kaldor, John

AU - Guy, Rebecca

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N2 - Background: Australian Aboriginal and Torres Strait Islander (Indigenous) peoples face major health disadvantage across many conditions. Recording of patients' Indigenous status in general practice records supports equitable delivery of effective clinical services. National policy and accreditation standards mandate recording of Indigenous status in patient records, however for a large proportion of general practice patient records it remains incomplete. We assessed the completeness of Indigenous status in general practice patient records, and compared the patient self-reported Indigenous status to general practice medical records. Methods: A cross sectional analysis of Indigenous status recorded at 95 Australian general practices, participating in the Australian Chlamydia Control Effectiveness Pilot (ACCEPt) in 2011. Demographic data were collected from medical records and patient surveys from 16 to 29 year old patients at general practices, and population composition from the 2011 Australian census. General practitioners (GPs) at the same practices were also surveyed. Completeness of Indigenous status in general practice patient records was measured with a 75% benchmark used in accreditation standards. Indigenous population composition from a patient self-reported survey was compared to Indigenous population composition in general practice records, and Australian census data. Results: Indigenous status was complete in 56% (median 60%, IQR 7-81%) of general practice records for 109,970 patients aged 16-29 years, and Indigenous status was complete for 92.5% of the 3355 patients aged 16-29 years who completed the survey at the same clinics. The median proportion per clinic of patients identified as Indigenous was 0.9%, lower than the 1.8% from the patient surveys and the 1.7% in clinic postcodes (ABS). Correlations between the proportion of Indigenous people self-reporting in the patient survey (5.2%) compared to status recorded in all patient records (2.1%) showed a fair association (r = 0.6468; p < 0.01). After excluding unknown /missing data, correlations weakened. Conclusions: Incomplete Indigenous status records may under-estimate the true proportion of Indigenous people attending clinics but have higher association with self-reported status than estimates which exclude missing/unknown data. The reasons for incomplete Indigenous status recording in general practice should be explored so efforts to improve recording can be targeted and strengthened.

AB - Background: Australian Aboriginal and Torres Strait Islander (Indigenous) peoples face major health disadvantage across many conditions. Recording of patients' Indigenous status in general practice records supports equitable delivery of effective clinical services. National policy and accreditation standards mandate recording of Indigenous status in patient records, however for a large proportion of general practice patient records it remains incomplete. We assessed the completeness of Indigenous status in general practice patient records, and compared the patient self-reported Indigenous status to general practice medical records. Methods: A cross sectional analysis of Indigenous status recorded at 95 Australian general practices, participating in the Australian Chlamydia Control Effectiveness Pilot (ACCEPt) in 2011. Demographic data were collected from medical records and patient surveys from 16 to 29 year old patients at general practices, and population composition from the 2011 Australian census. General practitioners (GPs) at the same practices were also surveyed. Completeness of Indigenous status in general practice patient records was measured with a 75% benchmark used in accreditation standards. Indigenous population composition from a patient self-reported survey was compared to Indigenous population composition in general practice records, and Australian census data. Results: Indigenous status was complete in 56% (median 60%, IQR 7-81%) of general practice records for 109,970 patients aged 16-29 years, and Indigenous status was complete for 92.5% of the 3355 patients aged 16-29 years who completed the survey at the same clinics. The median proportion per clinic of patients identified as Indigenous was 0.9%, lower than the 1.8% from the patient surveys and the 1.7% in clinic postcodes (ABS). Correlations between the proportion of Indigenous people self-reporting in the patient survey (5.2%) compared to status recorded in all patient records (2.1%) showed a fair association (r = 0.6468; p < 0.01). After excluding unknown /missing data, correlations weakened. Conclusions: Incomplete Indigenous status records may under-estimate the true proportion of Indigenous people attending clinics but have higher association with self-reported status than estimates which exclude missing/unknown data. The reasons for incomplete Indigenous status recording in general practice should be explored so efforts to improve recording can be targeted and strengthened.

KW - Aboriginal and/or Torres Strait islander people

KW - General practice

KW - Health data

KW - Indigenous status

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