Incomplete recording of Indigenous identification status under-estimates the prevalence of Indigenous population attending Australian general practices: a cross sectional study

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

doi:10.1186/s12913-019-4393-6

Abstract

BackgroundAustralian 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.MethodsA 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.ResultsIndigenous 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.ConclusionsIncomplete 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.Trial registrationACTRN12610000297022. Registered 13th April 2010.

Highlights

Australian Aboriginal and Torres Strait Islander (Indigenous) peoples face major health disadvantage across many conditions
496 General practitioners (GPs) from the 95 clinics provided a response; and 132 (27%) GPs were found to have greater than 75% complete recording of Indigenous status in their clinic patient records
This study found that almost half (44%) of patient records in the 95 general practice clinics had unknown or missing Indigenous identification status recorded

Summary

Introduction

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. Australian Aboriginal and Torres Strait Islander (hereafter Indigenous) peoples face major health disadvantage across a wide range of health conditions; including cancer, diabetes, and sexually transmissible infections (STIs) [1,2,3]. Recording of a patients’ Indigenous status in practice records is important to ensure optimal health care and evaluate the effectiveness of clinical practices services and programs [6] recommended for Indigenous patients. Indigenous adults are recommended to have annual health checks (Medicare Benefits Schedule (MBS) items 715 or 10,987) which provide preventive health strategies such as STI screening and detection of chronic disease risk factors [7]; and the CTG Pharmaceutical benefits scheme (PBS) co-payment reduces out-of-pocket costs of medicines for Indigenous people [8]. Complete Indigenous status in patient files provides a more accurate picture for monitoring disease prevalence, to identify risk and plan effective services and programs [6]

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