Analysing aggregate clinical data to support evaluation of the Tackling Indigenous Smoking program, 2014–16

Abstract

The aim of this study was to assess the change in recording of client population smoking attributes (smoking status recorded and smoking status) in Tackling Indigenous Smoking (TIS)-funded services compared with non-funded services for Aboriginal and Torres Strait Islander people, 2014-16. The study included a cohort of 152 Aboriginal-community controlled services with aggregate client smoking data from 2014 to 2016. Negative binomial regression was used to assess change in smoking status recorded and smoking status between TIS and non-TIS funded organisations. The models controlled for size of client population, jurisdiction and remoteness. From 2014 to 2016, the overall reporting rate (change in recording of smoking status) of client smoking status was 1.58-fold higher (95% confidence interval (CI) 1.30-1.91; P < 0.001) in TIS-funded than non-TIS-funded services after controlling for year, remoteness and their interaction. The highest change in reporting of client smoking status was for TIS-funded services in remote areas (reporting ratio 6.55; 95% CI 5.18-8.27; P < 0.001). In 2016, TIS-funded services reported higher overall levels of recording client smoking status (current, ex- and non-smokers) than non-TIS funded services (RR 1.11; 95% CI 1.00-1.28; P < 0.001). There was no significant change in the reporting of smokers, ex-smokers or non-smokers over the three reporting periods. The analysis shows higher reporting of the proportion of the service client population for services funded under the TIS program compared with non-TIS-funded services. Existing evidence suggests that following-up smokers with targeted clinical interventions once they have had smoking status recorded could reduce smoking rates in the long term. The public health contribution of this study has defined one method for assessing smoking attributes when using aggregate health service data. This method could be applied to future tobacco control programs in health services. Aboriginal and Torres Strait Islander smoking prevalence is high. The Aboriginal and Torres Strait Islander primary healthcare providers' national key performance indicators (nKPIs) are one data source that can track changes over time in smoking in clients of these services. This paper presents the first analytical study and evaluation of the nKPI dataset items on smoking. There is value in analysing routinely collected data in program evaluations. The method used in this paper demonstrates one approach that could be used to assess smoking indicators and their changes over time in TIS program evaluation.

Implementation strategies to increase smoking cessation treatment provision in primary care: a systematic review of observational studies

“…Participated in final examination: n = 2,314 patients (58.7%) Control clinics: 33 clinics, n = 3,162 patients. Participated in final examination: n = 2,107 patients (66.6%) Data source: Patient healthcare records, patient questionnaire Outcome measure: Practitioner-level: "Information on risk factors (smoking)" in patient healthcare records Patients were interviewed by a trainer interviewer, current smoker patients were asked whether they received "verbal advice or leaflets" regarding tobacco cessation, whether they were "referred to a specialist clinic", whether they received "pharmacotherapy", and whether they discussed "other methods" regarding tobacco cessation Patient-level: Patients reaching "prevention targets" ("not smoking"), but this seems to be 'non-smoking prevalence at final examination' Wright, 2018 [ 71 ] Australia 57. Fund and contract for the clinical innovation Cohort study Aboriginal and Torres Strait Islander people, aged 15 years and over, "has attended the health service [at least] three times in the past 2 years", 2014–2016 65% of all services that provide national key performance indicator (nKPI) data (152/233) were included: 44 TIS currently funded services and 108 non-TIS-funded services ‘Exposure’ was defined as an organisation that was funded ( n = 44/152) either directly or indirectly (via consortium arrangements) by the Australian Government’s TIS program 2016: n = 81,187 clients accessed TIS-funded services, n = 85,098 clients accessed non-TIS-funded services Data source: Aggregate service-level patient electronic health records; national key performance indicator (nKPI) data Outcome measure: "(1) the number (and proportion) of clients with a smoking status recorded in the health service records; and (2) the number (and proportion) of clients with smoking status recorded as current, ex- and non-smoker."…”

“…The included studies are ordered by implementation strategy domain (5, 7, 8 and 9 and ‘Multiple domains’). Within the domains, the studies are ordered by implementation strategy category then alphabetically by first author surname (Wright, 2018) [ 71 ] was excluded from narrative synthesis as it was at critical risk, but it is included in this table…”

Indigenous and Tribal Peoples Data Governance in Health Research: A Systematic Review

“…All 68 articles described the governance of data with at least one reference to Indigenous peoples [ 2 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ,…”

“… Community controlled organisations designing and collecting population health surveys [ 82 ]. Indigenous peoples and community-controlled organisations having a role in data collection and management [ 38 , 57 , 58 , 84 ]. Developing a First Nations client registry to consolidate demographic information from a variety of health systems [ 56 ].…”

“…Indigenous peoples and community-controlled organisations having a role in data collection and management [ 38 , 57 , 58 , 84 ].…”