Table 6.
Adjusted multilevel logistic regression analysis of health centre and client level factors on composite indicator of recommended STI testing and counselling services for female clients (n = 137 health centres; 7,670 female patient records)
| Outcome is 100% service delivery | Model A | Model B | Model C | ||||
|---|---|---|---|---|---|---|---|
| Predictors | Fixed effects | OR | 95% CI | OR | 95% CI | OR | 95% CI |
| Audit Year | 2007 | 1.00 | (reference) | 1.00 | (reference) | 1.00 | (reference) |
| 2008 | 0.73 | (0.45-1.18) | 1.04 | (0.63-1.74) | 1.13 | (0.66-1.91) | |
| 2009 | 0.70 | (0.43-1.14) | 0.87 | (0.52-1.45) | 0.88 | (0.52-1.50) | |
| 2010 | 0.58 | (0.35-0.95) | 0.75 | (0.44-1.29) | 0.75 | (0.43-1.30) | |
| 2011 | 0.44 | (0.27-0.71)a | 0.61 | (0.36-1.03) | 0.61 | (0.36-1.05) | |
| 2012 | 0.61 | (0.38-1.00) | 0.69 | (0.41-1.17) | 0.70 | (0.41-1.21) | |
| 2013 | 0.74 | (0.45-1.20) | 0.83 | (0.49-1.42) | 0.83 | (0.48-1.45) | |
| 2014 | 0.51 | (0.31-0.85) | 0.55 | (0.31-0.96) | 0.49 | (0.27-0.87) | |
| Health Centre Characteristics | |||||||
| Location | Urban | 1.00 | (reference) | 1.00 | (reference) | ||
| Regional | 0.34 | (0.16-0.72) | 0.34 | (0.16-0.73) | |||
| Remote | 1.05 | (0.56-1.98) | 1.10 | (0.59-2.06) | |||
| Duration of participation in ABCD CQI project | Baseline | 1.00 | (reference) | 1.00 | (reference) | ||
| 1-2 cycles | 1.41 | (1.16-1.70)b | 1.47 | (1.21-1.79)b | |||
| ≥3 cycles | 1.28 | (0.99-1.67) | 1.38 | (1.05-1.80) | |||
| Provided adult health checka | No | 1.00 | (reference) | 1.00 | (reference) | ||
| Yes | 2.11 | (1.83-2.44)b | 2.24 | (1.93-2.60)b | |||
| Provided Pap smear | No | 1.00 | (reference) | 1.00 | (reference) | ||
| Yes | 3.66 | (3.24-4.14)b | 4.39 | (3.84-5.03)b | |||
| Patient Characteristics | |||||||
| Age (years) | 15-19 | 4.53 | (3.23-6.34)b | ||||
| 20-24 | 5.62 | (4.04-7.81)b | |||||
| 25-29 | 3.82 | (2.73-5.34)b | |||||
| 30-24 | 3.21 | (2.28-4.51)b | |||||
| 35-39 | 2.18 | (1.53-3.10)b | |||||
| 40-44 | 1.54 | (1.08-2.19) | |||||
| 45-49 | 1.41 | (0.97-2.03) | |||||
| 50-54 | 1.00 | (reference) | |||||
| Aboriginal Status | Non-Aboriginal | 1.00 | (reference) | ||||
| Aboriginal | 1.33 | (0.98-1.81) | |||||
| Not recorded | 0.96 | (0.60-1.54) | |||||
| Random effects (intercepts) | |||||||
| State (variance (SE)) | 0.91 | (0.63) | 0.55 | (0.40) | 0.56 | (0.40) | |
| Health Centre (variance (SE)) | 0.76 | (0.14) | 0.44 | (0.087) | 0.43 | (0.085) | |
| State & Health Centre (variance) | 1.67 | 0.99 | 0.98 | ||||
| Patient (variance (SE)) | 0.31 | (0.16) | 0.11 | (0.057) | 0.023 | (0.013) | |
CQI continuous quality improvement, MOR Median Odds Ratio: odds of receiving above median service delivery if client was to change health centre or jurisdiction, OR odds Ratio, PCV proportional change in variance: per cent variation explained in odds for better healthcare delivery by introduction of health centre or client level factors, SRH Sexual and Reproductive Health
Due to multiple testing, the significance level is set at p < 0.005 (Bonferroni correction); a p < 0.005; b p < 0.0001
a(n = 6,645 with AHC recorded, introduced to audit tool in 2007)