BreastScreen Midland plan to improve the participation of Maori and Pacific women
in the Breast Screen Aotearoa programme 2013 - 2015
Background
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Breast Screen Midland (BSM) is one of eight lead providers funded by Breast Screen Aotearoa (BSA) of the National Screening Unit to provide a comprehensive service across Waikato Bay of Plenty and Lakes DHBs. The service offers eligible[1] women aged 45 to 69 years a free mammogram (breast x-ray) every two years as well as assessment and appropriate referral of any abnormalities detected. The well woman service encompasses recruitment, a call centre and mammography. Women can have a mammogram at permanent sites in Hamilton, Tauranga, the Mount, Whakatane, Rotorua or Taupo or on one of its two mobile units. Each town within the Waikato, and remote areas not easily accessible to the permanent sites are visited by a mobile unit every two years. During 2014-2015, BSM will introduce annual mobile visits to Tokoroa and Huntly in order to increase the participation of priority women in these areas of high need.
Between 1 July 2012 and 31 March 2014, the target of 70% coverage has not been achieved. A total of 62,929 screens have been performed, which equates to 66% coverage pro-rata[2]. For the same period, Maori coverage was 59% and Pacific Island coverage 57%. As Other ethnicities coverage was 67%, there is still a disparity that needs addressing.
This data is for the 45-69 year old cohort; BSA sets targets based on 50-69 year olds, which raises the above coverage data by about 1% for each cohort.
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The National Screening Unit sets targets based on 50-69 year olds. The following data is therefore based on this subset of women, and are the Year to Date screening values as per BSA coverage reports in Reporting Services – as at 30 April 2014, with screening data complete to 31 Mar 2014.
TLA / Eligible / Eligible / Eligible / EligibleOTHER / Number Screened / Coverage % / MAORI / Number Screened / Coverage % / PACIFIC / Number Screened / Coverage % / TOTAL / Number Screened / Coverage %
Hamilton City / 12210 / 7009 / 57.40% / 1990 / 943 / 47.39% / 280 / 146 / 52.14% / 14480 / 8098 / 55.93%
Hauraki District / 1980 / 1162 / 58.69% / 350 / 146 / 41.71% / 25 / 14 / 56.00% / 2355 / 1322 / 56.14%
Matamata-Piako District / 3290 / 2423 / 73.65% / 390 / 194 / 49.74% / 15 / 10 / 66.67% / 3695 / 2627 / 71.10%
Otorohanga District / 740 / 571 / 77.16% / 220 / 109 / 49.55% / 5 / 2 / 40.00% / 965 / 682 / 70.67%
South Waikato District / 1800 / 1298 / 72.11% / 570 / 350 / 61.40% / 170 / 95 / 55.88% / 2540 / 1743 / 68.62%
Thames-Coromandel District / 4480 / 1708 / 38.13% / 410 / 97 / 23.66% / 35 / 16 / 45.71% / 4925 / 1821 / 36.97%
Waikato District / 4460 / 2587 / 58.00% / 1070 / 553 / 51.68% / 25 / 16 / 64.00% / 5555 / 3156 / 56.81%
Waipa District / 5110 / 3402 / 66.58% / 630 / 295 / 46.83% / 35 / 20 / 57.14% / 5775 / 3717 / 64.36%
Waitomo District / 820 / 517 / 63.05% / 390 / 178 / 45.64% / 5 / 5 / 100.00% / 1215 / 700 / 57.61%
Waikato DHB / 34890 / 20677 / 59.26% / 6020 / 2865 / 47.59% / 595 / 324 / 54.45% / 41505 / 23866 / 57.50%
Kawerau District / 255 / 263 / 103.14% / 370 / 176 / 47.57% / 15 / 8 / 53.33% / 640 / 447 / 69.84%
Opotiki District / 730 / 409 / 56.03% / 650 / 288 / 44.31% / 15 / 5 / 33.33% / 1395 / 702 / 50.32%
Tauranga City / 13530 / 8120 / 60.01% / 1570 / 749 / 47.71% / 90 / 68 / 75.56% / 15190 / 8937 / 58.83%
Western Bay of Plenty District / 6050 / 3437 / 56.81% / 810 / 333 / 41.11% / 40 / 19 / 47.50% / 6900 / 3789 / 54.91%
Whakatane District / 2940 / 2052 / 69.80% / 1380 / 771 / 55.87% / 15 / 20 / 133.33% / 4335 / 2843 / 65.58%
BoP DHB / 23505 / 14281 / 60.76% / 4780 / 2317 / 48.47% / 175 / 120 / 68.57% / 28460 / 16718 / 58.74%
Rotorua District / 6040 / 3610 / 59.77% / 2370 / 1225 / 51.69% / 120 / 59 / 49.17% / 8530 / 4894 / 57.37%
Taupo District / 3600 / 2249 / 62.47% / 910 / 462 / 50.77% / 55 / 19 / 34.55% / 4565 / 2730 / 59.80%
Lakes DHB / 9640 / 5859 / 60.78% / 3280 / 1687 / 51.43% / 175 / 78 / 44.57% / 13095 / 7624 / 58.22%
BSM / 68035 / 40817 / 59.99% / 14080 / 6869 / 48.79% / 945 / 522 / 55.24% / 83060 / 48208 / 58.04%
It is noticeable that significant disparities exist within BSM. One of the issues previously identified was that the district health boards did not have enough local ownership. Therefore since 1 July 2008, each DHB has been responsible for its own breast and cervical screening recruitment and retention and Support To Services (STS). Bay of Plenty contracts Te Kupenga Hauora and Te Puna Ora o Mataatua in the Western and Eastern areas respectively. Each provides one full time equivalent to promote and provide STS for the breast and cervical screening programmes. Lakes DHB contracts each PHO, RAPHS (Rotorua) and Midland Health Network – Taupo Locality, to provide the same service. Waikato DHB is contracted by the NSU to provide recruitment and retention activity within its own DHB and to co-ordinate activity across BSM. The NSU contracts Raukura Hauora o Tainui directly to provide recruitment and retention activity as well as STS for both screening programmes in the Waikato rohe. Waikato DHB is not currently contracted to provide STS.
Contracted services / Waikato DHB / BoP DHB / Lakes DHBMammography services / Multiple / Bay Radiology / Lakes Radiology
Assessment / Waikato Hospital / Bay Radiology Tauranga Site / Lakes Radiology Rotorua site
Lead provider service specification components:
1. Regional leadership and co-ordination
2. Development and implementation of a biennial Regional Coordination Plan in partnership with other regional providers and stakeholders
3. Engagement with regional stakeholders
4. Regional reporting / Waikato DHB Population Health: Screening Services
Dual Independent Service Providers (ISPs) service specification components;
1. Development and implementation of a biennial Regional Services Plan in partnership with your regional BSA Lead provider and other regional providers stakeholders
2. Engagement with regional stakeholders
3. Provision of Support to Services to BSA screening, assessment and treatment
4. Regional reporting / Raukura Hauora o Tainui (1 fte) / Te Kupenga Hauora o Tauranga Moana – Western BoP (0.5fte)
Te Puna Ora o Mataatua – Eastern BoP (1fte) / RAPHS, Rotorua (0.5fte)
Midland Health Network – Taupo Locality (0.5fte)
Contractor / NSU / DHB Planning and Funding / DHB Planning and Funding
Funder / NSU / NSU / NSU
Of course, it is not just the responsibility of the Independent Service Providers (ISPs) to improve coverage, but is incumbent on us all to work together to develop systems that will achieve better health equity. It is usually effective health systems that will have greatest impact and will then reduce the individual activity and manual systems needed to encourage the remaining women into the service.
Despite a renewed focus on achieving equity by the whole BSM team has seen Maori coverage improve from 39% at the end of January 2009 to 59% at the end of March 2014. Pacific coverage has also improved, going from 45% at the end of 2009 to 57% at the end of March 2014. In 2010, the BSM developed and implemented a plan to improve coverage and increase equity that has resulted in a 5% and 8% increase in coverage for the respective cohorts. This plan focussed on improving service delivery across the whole continuum and made it “everyone’s business”.
“Ehara taku toa I te toa takitahi, engari he toa takitini”
“My strength is not that of a single warrior, but that of many”.
In July 2011, the political emphasis changed from health promotion to targeted activity. ISPs have responded by changing their work methodology adpting a personal health approach. This plan seeks to build on their strengths and be more specific on the outputs required to achieve success.
Vision
Moving forward towards equity, 70% coverage and shared responsibility.
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Action Plan
Targets
Targets are set and overall performance is monitored in the BSM performance monitoring spreadsheet; this is updated and circulated to all key stakeholders monthly. The information provided measures performance per DHB and ethnicity against the 70% coverage target and will be measured against the following data.
COVERAGE PERFORMANCE / Jul-13 / Aug-13 / Sep-13 / Oct-13 / Nov-13 / Dec-13 / Jan-14 / Feb-14 / Mar-14 / Apr-14 / May-14 / Jun-14 / TotalCOVERAGE WEIGHTING (BUDGET) / 9.71% / 9.71% / 8.86% / 8.86% / 9.71% / 2.57% / 4.57% / 8.00% / 9.71% / 8.86% / 9.71% / 9.71% / 100.00%
Waikato DHB target / 1806 / 1953 / 1808 / 1822 / 1810 / 1037 / 1746 / 1535 / 1801 / 1619 / 1903 / 1735 / 20574
Waikato DHB cumulative target / 1806 / 3759 / 5567 / 7389 / 9199 / 10236 / 11982 / 13516 / 15317 / 16937 / 18839 / 20574 / 0
BoP DHB target / 1,217 / 1,316 / 1,218 / - / 1,219 / - / - / 1,034 / 1,213 / 1,091 / 1,282 / 1,169 / 10758
BoP DHB cumulative target / 1217 / 2532 / 3750 / 3750 / 4969 / 4969 / 4969 / 6003 / 7217 / 8307 / 9589 / 10758 / 0
Lakes DHB target / 499 / 540 / 499 / 503 / 500 / 0 / 0 / 424 / 498 / 447 / 526 / 479 / 4916
Lakes DHB cumulative target / 499 / 1039 / 1538 / 2042 / 2542 / 2542 / 2542 / 2966 / 3463 / 3911 / 4436 / 4916 / 0
BSM target / 3521 / 3809 / 3525 / 2326 / 3529 / 1037 / 1746 / 2993 / 3512 / 3157 / 3710 / 3382 / 36247
Maori cumulative screening volumes, 2013/14
2013/14 / Daily target / Jul-13 / Aug-13 / Sep-13 / Oct-13 / Nov-13 / Dec-13 / Jan-14 / Feb-14 / Mar-14 / Apr-14 / May-14 / Jun-14 / Total
Maori Waikato Target / 13 / 265 / 293 / 268 / 246 / 254 / 66 / 120 / 255 / 305 / 269 / 277 / 284 / 2902
Maori BoP Target / 10 / 210 / 232 / 213 / 195 / 201 / 52 / 95 / 202 / 242 / 213 / 219 / 225 / 2300
Maori Lakes Target / 7 / 144 / 160 / 146 / 134 / 138 / 36 / 65 / 139 / 166 / 147 / 151 / 155 / 1582
Maori BSM Target / 30 / 619 / 685 / 628 / 576 / 593 / 153 / 281 / 596 / 713 / 629 / 647 / 664 / 6783
PI cumulative screening volumes, 2013/14
2013/14 / Daily target / Jul-13 / Aug-13 / Sep-13 / Oct-13 / Nov-13 / Dec-13 / Jan-14 / Feb-14 / Mar-14 / Apr-14 / May-14 / Jun-14 / Total
PI - Waikato Target / 1 / 27 / 29 / 43 / 30 / 36 / 8 / 12 / 22 / 32 / 22 / 24 / 25 / 310
PI - BoP Target / 1 / 9 / 9 / 13 / 10 / 11 / 2 / 4 / 7 / 10 / 7 / 8 / 8 / 98
PI - Lakes Target / 1 / 8 / 8 / 12 / 9 / 10 / 2 / 4 / 6 / 9 / 6 / 7 / 7 / 88
PI - BSM Target / 3 / 44 / 47 / 68 / 49 / 57 / 12 / 20 / 35 / 52 / 35 / 38 / 40 / 495
Objective 1: Enhancing Maori and Pacific Island recruitment
Goal Outcome / Strategy / Action / Output / Provider report /Achieve 90% enrolment of Priority women eligible but not enrolled in BSA per each general practice so that 70% coverage can be achieved. / ISPs to support low performing general practices as a one off strategy to enrol sufficient women to achieve 70% coverage / Support at least two low performing GP practices with a high volume and/or proportion of priority, per annum, to enrol and book.
Timelines and targets are based on completing the project within 2 months of data match report being produced.
ISP works on-site at two practices to enrol and book women into the BSA programme. / Taupo Health Centre:
· Increase enrolments by 10% to achieve 90%.
· Increase BSA screening volumes by 10% to achieve 73%
Taupo Medical Centre:
· Increase enrolments by 10% to achieve 86%.
· Increase BSA screening volumes by 10% to achieve 70%. / Worked in Taupo Medical Centre to help increase enrolments between February and April. Total of 6 visits to the practice to work on enrolments. 27 women enrolled during this time with half of these women also booking mammogram appointments when enrolling. Met with Medical Care assistant and nurse at Taupo Medical Centre to provide ideas on how they can improve their current enrolment rate, and showed them how to enrol women through Medtech. Follow up within the next month.
No support provided to Taupo Health Centre as yet due to my focus being changed to Pihanga Health enrolment support. Will offer my support after the departure of the Mangakino mobile.
An increase in the number and % of Priority women enrolled with the BSA programme / Develop a comprehensive workplan which will identify actions and timelines that reflect this Plan.
Escalate, within four weeks, to the BSM coordinator and the DHB portfolio manager if there are timeline constraints. / Workplan developed (using template below) with clear outputs and timeframes to include:
1. Working in partnership with Maori Health team in each DHB (Waikato, Bay of Plenty and Lakes) in BSM region
2. Establish at least one key stakeholder group to plan and increase recruitment of priority women.
3. Two GP recruitment projects
4. Mobile visit support (utilise approved Mobile Support Guidelines)
5. At least four targeted education seminars.
6. Developing partnership, and a project plan, with one workplace with a high Maori and Pacific employee base to increase the screening rate of that population / 1. Workplan completed and progressed at 2 monthly BSM catch ups.