detection and treatment of pre-cancerous squamous cell changes. ⢠Regular cervical smear tests are the best preventati
National Cervical Screening Programme Smear taker update – Waikato DHB May 2016 Clare Coles, Manager NCSP, Waikato DHB Acknowledging Deborah Mills, Senior Portfolio Manager, NCSP, MoH
DATE FOR DIARY 29 September 2016 IMMUNISATION WORKSHOP
NCSP Key Messages •
Our NCSP is one of the most successful cervical screening programmes in the world.
•
We are reducing the incidence and mortality rate of cervical cancer by the detection and treatment of pre-cancerous squamous cell changes.
•
Regular cervical smear tests are the best preventative against cervical cancer, and screening every three years is recommended for women aged 20 to 70 years who have ever been sexually active.
•
Cervical cancer is one of the most preventable of all cancers and screening women every three years can reduce the risk of developing it by up to 90 percent.
Reducing the incidence and mortality of cervical cancer
National coverage Feb 2016
Waikato DHB coverage by ethnicity 90
80
70
60 2013
50
2014 2015
40
2016 30
20
10
0 Total
Asian
Maori
Pacific
Other
How many women need a smear still to reach target?
Ethnicity
Additional Women 3-year screens to Population screened in coverage reach 80% last 3 years target
Māori
19,167
12,495
65.2%
2,839
Pacific
2,397
1,794
74.8%
124
Asian
8,859
5,636
63.6%
1,451
European/Other
67,436
53,906
79.9%
43
Total
97,859
73,831
75.4%
4,457
NCSP Quality initiatives •
Achieving equity - Maori Health Plans - Free smears - Support to screening services
•
Monitoring the performance of the programme
•
NCSP-Register management
•
Laboratories and colposcopy monitoring and audit
•
Working with regional services to improve programme delivery
Free smears for Priority Women
All practices, Family Planning and two Pacific Island providers can offer free smears to (overdue) Priority women. Priority women as defined by NCSP • Māori • Pacific • Asian • Any other woman aged between the age of 30-69 years who: – Never had a smear – Overdue for a cervical smear for five years
Free smears for SIGNIFICANTLY OVERDUE Priority Women
• • •
“Significantly Overdue Women” defined as Priority Women aged 30 years or older and never screened or who are overdue by more than five years
•
Claim is INSTEAD OF Priority woman clain
Free smears for SIGNIFICANTLY OVERDUE Priority Women
•
$50 per Significantly Overdue Woman screened during normal working hours noting that additional effort is usually required to locate, book and screen these women eg contacting them out of normal working hours (after 1700 or before 0800 or anytime during the week-end) to book appointment.
•
$75 per Significantly Overdue Woman screened in her home or by an outreach service (PHO or general practice).
•
$75 per Significantly Overdue Woman screened outside of normal working hours (after 1700 or before 0800 or anytime during the week-end).
Informing women of abnormal results
•
There are sometimes complaints where smear takers have not informed women about what will happen if there is an abnormal result or that they have had an abnormal smear result
•
The NCSP-Register letters are a good back up but the primary responsibility is with the smear taker
•
This is important for women to understand and be able to ask questions and get further information or support if they need it.
Correct labelling of smears
•
If you don’t label the smear vial correctly, the lab may have to discard the specimen and the woman may need to return for another smear.
•
The vial should be labelled the woman’s: - family or surname and given names, and - NHI number. Ideally, date of birth will be included too.
•
On the lab request form, please also record the woman’s: - ethnicity (to measure coverage) - street address (so Register letters can be sent)
Labelling smear vials continued
•
Things to watch for are: - mixing up mothers and daughters - using today’s date, not the date of birth! - details on the form and the vial need to match - missing NHI numbers or date of birth - completely unlabelled specimen vials.
Engaging women to have smears
•
Promotion of “wellness” is powerful – a call to action. We are preventing cancer.
•
Low knowledge of cervical screening – younger women don’t know anyone who has had cervical cancer. “Lack of importance” of cervical cancer.
•
“abnormal cells/ precancerous cells” are confused with cancer
•
Personal engagement is better than compliance brought by nagging.
•
Women had a smear when they wanted the pill. Not prepared for having a smear; don’t understood why they need to have routine smears.
A woman’s experience •
Women interviewed pulled back in their chairs, held themselves rigid, screwed up their faces, clenched their fists and gritted their teeth when they recalled their screening experiences.
•
The test procedure is a “big deal” and they need a “big reason” to come back. Women felt violated, trust was broken.
•
A women’s equilibrium is shaken and not re-established before they leave – “a cup of tea would have been nice!”
•
Poor previous experience (eg unexpected pain) prevents ongoing participation. Warn women there may be discomfort, and don’t minimise it.
•
Game of “cat and mouse” with primary care re having smears. The importance of screening to primary care is out of line with the importance women place on it. The “health system’s” test, not “my” test.
It can be a good experience! • • • • • • • • • • • •
“Very easy person to talk to. Different position was nice. Great manner. Love your nursing philosophy.” “Appreciated being given options. Enjoyed L) lateral position (for first time).” “You are wonderful – the best nurse I’ve ever met! Felt so comfortable and safe” “It’s been lovely coming here” “Most painless experience. Didn’t even know it was being done” “Fantastic. Easiest smear ever!” ”Painless and comfortable (after past experiences). Felt safe and relaxed”. “So glad I did it and got you. Much easier and nicer than I expected” (first smear) “Fantastic – You were wonderful. Best smear ever (usually very painful)” “What a relief after last traumatic experience! So relieved it was so easy”. “Best smear ever; awesome; easy”. “Relaxed and enjoyable”.
Champions
•
Be a cervical screening champion in your practice!
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Work with your PHO to get electronic data matching information and have completely up to date recall lists
•
Try innovative and personalised methods to engage women
•
Refer women to alternative screening locations as appropriate
•
The DHB regions with the best coverage have great regional coordination and leadership to engage primary care and support them to reach the women.
Finding women who need smears – PHO data match report • Available monthly through your PHO • Matches data between the PHO Register and the NCSP Register • Can find women who have smears elsewhere • Supports practices to know who to call for a smear • May identify women who have “fallen through the gaps” • Training available – excel spreadsheet • Replaces paper reports from the NCSP Register
SAMPLE PHO NCSP Cervical Screening Datamatch Report QUARTER _START
PHO_I PR_ID PRACTICE D _NAME
ETH ETH_ ETH_ NHI_ _1 2 3
NUMBER
PHO_ SUBMIT_ BIRTH_ NHI_ NUMBER
DATE
LAST_ SCREEN SCREENED_ ENROLMENT THIS_ _STATUS QUARTER
EVENT_TYPE LOCATION_OF_LAS T_SCREEN
CMI NEXT_ DUE_DATE
WITHDRAWL _DATE
QUINTILE
3
01-Jan-2016 XXX
123
XXX
11
ABC2222 ABC2222
11-Dec-1983 17-Jun-2004
ENROLLED
STUDENT CYTOREQ HEALTH OTAGO
N 17-Jun-2005
01-Jan-2016 XXX
123
XXX
11
ABC3333 ABC3333
15-Dec-1967 06-Dec-2010
ENROLLED
CYTOREQ X Practice
H 06-Jan-2012
L 08-Feb-2016
01-Jan-2016 XXX
123
XXX
21
ABC1111 ABC1111
24-Jan-1995 08-Jan-2015
ENROLLED
FAMILY PLANNING CYTOREQ AUCK
01-Jan-2016 XXX
123
XXX
11 99 99 ABC0000 ABC0000
11-Sep-1968 08-Mar-2013
ENROLLED
CYTOREQ X Practice
N 08-Apr-2016
01-Jan-2016 XXX
123
XXX
11
ABC9999 ABC9999
16-Mar-1950 08-Jan-2016
ENROLLED
CYTOREQ X Practice
N 08-Feb-2019
01-Jan-2016 XXX
123
XXX
11
ABC6666 ABC6666
08-Oct-1947 09-Dec-2014
ENROLLED
GYNAE INPATIENT HISTOREQ WARD
N
01-Jan-2016 XXX
123
XXX
11
ABC7777 ABC7777
15-Jul-1950 29-Oct-2003
ENROLLED
CYTOREQ X Practice
N
01-Jan-2016 XXX
123
XXX
11
ABC4444 ABC4444
02-Aug-1983
01-Jan-2016 XXX XX 01-Jan-2016X
123 123
XXX XXX
11 11
ABC5555 ABC0001 ABC0001 ABC0001
11-Mar-1965 19-Mar-1969 05-Aug-2015
WITHDRAWN ENROLLED
18-May-2005
XX 01-Jan-2016X
123
XXX
31
ABC0002 ABC9999
02-Jun-1956
ENROLLED
Yes
10-Feb-2015
CYTOREQ X Practice
N
10-Mar-2018
HOW TO INTERPRET Screened elsewhere The smear is overdue
5
High grade smear The smear is overdue
2
Screened elsewhere Low grade smear The smear is due
4
Normal smear The smear is due in 3 months time
4
Patient screened this quarter Next due 2019
5
Tracking Turned off (Probable Treatment in Secondary Care)
4
Tracking Turned off (e.g. Hysterectomy, overseas, serious illness)
5
Patient is not on the NCSP Register
2
Withdrawn from the NCSP Register
3
No results recorded on the NCSP Register, or this is a synopsis result (incomplete information).
3
Note there are two different NHIs. Column H is the 'live' NHI used by the MoH; Column I is the NHI used by the PHO at the last Register submission. The fact it is different to the NHI in the previous column denotes it is a 'non-master' or 'dormant' NHI being used by the PHO.
Questions?
