INDIGENOUS HEALTH
The recording of Aboriginal and Torres Strait
Islander status in general practice clinical records:
a cross-sectional study
Allison Thomson,1 Simon Morgan,2 Peter O’Mara,3,4 Amanda Tapley,2 Kim Henderson,2 Mieke van Driel,5
Christopher Oldmeadow,6 Jean Ball,6 John Scott,2 Neil Spike,7,8 Lawrie McArthur,9 Parker Magin1,2
R
ecording of Aboriginal and Torres
Strait Islander status in health care
settings has been identified as a key
issue in addressing the Council of Australian
Government’s commitments to ‘Closing the
Gap’(CTG).1
Abstract:
Objectives: To document the frequency of recording of Aboriginal and Torres Strait Islander
status in general practice (GP) clinical records and to establish associations of this recording.
Methods: Cross-sectional analysis of recording of patients’ Aboriginal and Torres Strait Islander
status in GP clinical records from GP training practices in four Australian states.
Accurate recording of Aboriginal and Torres
Strait Islander status is important to both
the individual patient and to the greater
public health for a number of reasons.
These include the planning, monitoring
and evaluation of health services,1,2 such as
estimates of the health disparity gap between
Aboriginal and Torres Strait Islanders and nonIndigenous Australians,3 and assessing the
effectiveness of public health interventions
such as immunisation programs.4 But, most
importantly, identification of Aboriginal
and Torres Strait Islander status is a vital
component of high-quality patient care.
Aboriginal and Torres Strait Islander status
is considered an important element of
clinical decision making due to the differing
health needs of this population.5 This is
reflected in specific clinical guidelines for
Aboriginal and Torres Strait Islander patients,
for example, when assessing cardiovascular
risk.6 Delivering culturally safe healthcare
also requires the clinician to be aware of a
patient’s Aboriginal and Torres Strait Islander
status.7 In addition, knowledge of a patient’s
Aboriginal and Torres Strait Islander status
Results: Of the 9,704 clinical records examined, the patients’ Aboriginal and Torres Strait
Islander status had been documented in 5,165 (53.2%). Higher rates of recording were
associated with older patient age, practices outside a major city, patients who were not new
to the practice and the patient being Aboriginal and Torres Strait Islander. In encounters with
Aboriginal and Torres Strait Islander patients, the patient’s status had been documented in 82%
of records. Those attending larger practices were less likely to have had their status recorded.
Conclusions: This is the first report of Aboriginal and Torres Strait Islander status recording in
GP clinical records. Almost 20% of Aboriginal and Torres Strait Islander patients did not have
their status recorded in the clinical record, with indications that recording may be unsystematic.
Implications: Our findings reinforce the need for a systematic approach to identification
of Aboriginal and Torres Strait Islander status in general practice and will inform policy and
practice in this important area.
Key words: Indigenous Australians, health records, personal, family practice, general practice
enables patients to be offered specific GPmediated health initiatives such as Aboriginal
and Torres Strait Islander health checks and
the CTG medication scheme.8
Despite the importance of accurate recording
of status, Aboriginal and Torres Strait Islander
people are under-identified in many health
data sets.2 Data about frequency of recording
of Aboriginal and Torres Strait Islander status
comes largely from tertiary institutions and has
not previously been documented in primary
care.1,9 In the hospital setting, it is estimated
that 12% of Aboriginal and Torres Strait
Islander patients are not correctly identified.10
Aboriginal and Torres Strait Islander status has
also been shown to be under-identified on up
to 27% of death records.11
General practice is the cornerstone of
Australian primary care12 and, as such, has a
vital role in the provision of health care for
Aboriginal and Torres Strait Islander people.1
While Aboriginal Community Controlled
1. Discipline of General Practice, University of Newcastle, New South Wales
2. General Practice Training Valley to Coast, New South Wales
3. School of Medicine and Public Health, Faculty of Health and Medicine; University of Newcastle, New South Wales
4. Wollotuka Institute, University of Newcastle, New South Wales
5. Discipline of General Practice, University of Queensland
6. Clinical Research Design IT and Statistical Support Unit, Hunter Medical Research Institute, New South Wales
7. Department of General Practice, University of Melbourne, Victoria
8. Victorian Metropolitan Alliance
9. Adelaide to Outback GP Training, South Australia
Correspondence to: Professor Parker Magin, General Practice Training Valley to Coast, Newbolds Building – Gavey St, Mayfield, Newcastle, NSW 2304;
e-mail: Parker.magin@newcastle.edu.au
Submitted: September 2014; Revision requested: November 2014; Accepted: February 2015
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
The authors have stated they have no conflict of interest.
Aust NZ J Public Health. 2016; 40 (Suppl. 1) S70-S74; doi: 10.1111/1753-6405.12400
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Australian and New Zealand Journal of Public Health
© 2015 The Authors
Vol. 40 (Suppl. 1) 2016
General practice recording of Aboriginal and Torres Strait Islander status
Health Services (ACCHS) have been
established to provide care for Aboriginal and
Torres Strait Islander people, recent figures
suggest that 50–60% of Aboriginal and
Torres Strait Islander patients access health
care outside of these organisations.13,14 In
Australia, Aboriginal and Torres Strait Islander
patients account for about 1.6% of general
practice consultations.15
In Australian general practice, sub-optimal
collection and recording of Aboriginal and
Torres Strait Islander status is proposed to
be a long-standing problem.1 However,
evidence regarding prevalence of Aboriginal
and Torres Strait Islander status recording is
lacking. Recently, steps have been taken to
improve recording with changes to practice
accreditation standards specifying that
practices must routinely record Aboriginal
and Torres Strait Islander status in patient
health records.5 It is recommended that
questions about Aboriginal and Torres
Strait Islander status be part of new
patient registration information.9 Previous
studies have examined general practice
procedures, rather than individual clinical
files, and demonstrated that only a minority
of mainstream practices had routine
identification procedures in place.9,16
major cities through to very remote practices
in four Australian states (New South Wales,
Victoria, Tasmania and South Australia). Data
collection for the ReCEnT project takes place
within mainstream general practices. No
Aboriginal Community Controlled Health
Services are included in the analysis.
routinely bulk bills (i.e. there is no out-ofpocket expense to the patient). Practice
postcode was used to define the Australian
Standard Geographical Classification –
Remoteness Area (ASGC-RA)20 (the degree of
rurality) and the SEIFA code of the practice
location.
Characteristics of the participating practices
are recorded by each registrar each term, on a
paper based questionnaire.
Statistical analysis
Participating GP registrars undergo faceto-face orientation in how to complete
the patient encounter forms and record
encounter data on the paper data collection
instrument. The collected data includes
patient demographics, including Aboriginal
and Torres Strait Islander status. Registrars are
requested to directly ask each patient their
Aboriginal and Torres Strait Islander status
according to best practice.18 GP registrars
record the details of 60 consecutive patient
encounters each training term.
For one round of data collection in the second
half of 2012, an additional question was
added to the data collection instrument. This
question was: “Was the patient’s Aboriginal
and/or Torres Strait Islander status documented
in the clinical record prior to this consultation?”
Response options were ‘yes’ or ‘no’.
Previous studies have examined barriers
to identification of Aboriginal and Torres
Strait Islander patients in general practice.
Such barriers have included a lack of
routine processes for identification,9 lack of
awareness of the importance of identification,
apprehension regarding reactions of patients
to the question, and assumptions that
Aboriginal and Torres Strait Islander patients
did not attend particular practices.16
This study aimed to document the prevalence
of recording of Aboriginal and Torres Strait
Islander status in the individual patient’s
clinical record and to establish patient and
practice associations of this recording in
general practice.
Outcome factors
The primary outcome factor was prior
recording of Aboriginal and Torres Strait
Islander status in the individual patient’s
clinical record. Records from encounters
where there was prior recording of status
were compared to all other clinical records of
patients included in the study.
A secondary analysis was performed that
included only patients of Aboriginal and
Torres Strait Islander background. Records
from encounters where prior recording of
status had occurred were compared to all
other clinical records of Aboriginal and Torres
Strait Islander patients.
Independent variables
Methods
This was a cross-sectional analysis of practice
data collected during general practice
consultations as part of the Registrar Clinical
Encounters in Training (ReCEnT) cohort study.
The ReCEnT study methodology has been
described in detail elsewhere.17 Briefly,
ReCEnT is an ongoing cohort study of the
clinical and educational content of GP
registrar encounters with patients. It is
undertaken in four general practice regional
training providers (RTPs), encompassing
Vol. 40 (Suppl. 1) 2016
Independent variables were categorised as
patient or practice factors.
Patient factors were age, gender, Aboriginal
and Torres Strait Islander status, non-English
speaking background (NESB), new patient to
registrar, and new patient to practice (that is,
not having previously attended the practice).
Practice factors included rurality, decile of the
Socioeconomic Index for Area (SEIFA) Relative
Index of Disadvantage,19 number of GPs
working at the practice, use of computerised
medical records and whether the practice
Analysis was performed on one round of data
collection from 2012.
For the primary outcome of whether
Aboriginal and Torres Strait Islander status
had been recorded in the clinical record,
univariable associations with independent
variables were tested with logistic regression
within a generalised estimating equations
(GEE) framework to account for clustering of
consultations within registrars. Multivariable
analysis was then performed using logistic
regression within a GEE framework to
account for clustering of consultations within
registrars.
For the second analysis confined to patients
of Aboriginal and Torres Strait Islander
background, univariable associations
with independent variables were tested
with logistic regression within a GEE
framework. Multivariable analysis was then
performed using logistic regression within
a GEE framework and exact methods were
used when there were small numbers of
observations.
For both outcomes, variables with a p-value
<0.20 and a relevant effect size in the
univariable analysis were included in the
multiple regression model.
To analyse the effect of missing data on
results, further analyses employing multiple
imputation were performed using chained
regressions to generate 10 imputed data
sets. Missing values were predicted (under
the missing at random assumption) using
an iterative series of appropriate regression
models conditional on the observed value
of the outcome variable. Coefficients and
standard errors for the variability between
imputations were combined using the
method of Rubin.21 All regression analyses
were performed using SAS v9.4 (SAS Institute
Inc., Cary, NC, USA) and multiple imputation
using Stata v13 (Statacorp, College Station,
TX, USA).
Statistical significance was set at the 0.05 level.
Ethics approval for the study was obtained
from the Human Research Ethics Committee
of the University of Newcastle, NSW. H-20120110.
Australian and New Zealand Journal of Public Health
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Thomson et al.
Results
The response rate of registrars for the ReCEnT
project for this round of data collection was
94.7%. There were 13,078 patient encounters,
collected from 152 practices by 217 registrars.
The question regarding prior recording of
Aboriginal and Torres Strait Islander status
was answered in 9,704 encounters (74.2%).
Table 1 shows the characteristics of the
patients and practices in this study and their
univariable associations with status recording.
Of the 9,704 valid encounters, 3,675 (37.9%
[95%CI: 36.9-38.8]) were with male patients.
The mean age of patients was 39.9 years.
Of these encounters, 117 (1.2% [95%CI:
0.9-1.4]) were with patients who identified as
Aboriginal and Torres Strait Islander. Practices
were from locations across ASGC-RA20 codes
1 to 5, reflecting major cities through to very
remote practice locations.
Univariable associations of status recording in
Aboriginal and Torres Strait Islander patients
are presented in Table 2.
Table 1: Characteristics associated with recording the patient’s Aboriginal and Torres Strait Islander status
(n=9,704a).
Variable
Patient age group
Class
<15
15 to <31
929 (45%)
1,139 (55%)
31 to <55
1,451 (48%)
1,591 (52%)
Patient gender
55+
Male
1,234 (44%)
1,776 (48%)
1,569 (56%)
1,899 (52%)
0.37
Aboriginal or Torres Strait Islander
Female
No
2,681 (46%)
4,518 (47%)
3,170 (54%)
5,069 (53%)
<0.001
Non-English Speaking Background
Yes
No
21 (18%)
4,096 (46%)
96 (82%)
4,778 (54%)
0.55
New patient to the registrar
Yes
No
270 (52%)
1,899 (43%)
249 (48%)
2,502 (57%)
<0.001
New patient to surgery
Yes
No
2,546 (49%)
4,051 (45%)
2,612 (51%)
4,898 (55%)
<0.001
Practice sizec
Yes
Small
445 (67%)
1,325 (47%)
223 (33%)
1,504 (53%)
0.89
Does the practice routinely bulk billd
Large
No
3,175 (47%)
3,860 (49%)
3,563 (53%)
3,939 (51%)
0.025
Rurality
Yes
Major city
628 (34%)
2,979 (53%)
1,199 (66%)
2,682 (47%)
0.021
Inner regional
1,101 (37%)
1,837 (63%)
459 (42%)
646 (58%)
6.6 (2.2)
6.4 (2.2)
Of practices included in our study, 98.2% used
computerised medical records.
Outer regional/
Remote/Very remote
mean (SD)
SEIFA Index (decile)
All patients including non-Aboriginal
and Torres Strait Islander patients
0.60
a: Numbers may not add to 9704 due to missing data
b: Logistic regression adjusted for clustering
c: Practices defined as small if less than 6 GPs were working in the practice
d: Practices were defined as routinely bulk-billing if all patients were routinely bulk-billed.
In 53.2% (5,165 of 9,740 [95%CI: 52.2-54.2])
of all patient encounters, the patient’s
Aboriginal or Torres Strait Islander status had
been documented in the clinical record prior
to the consultation.
Aboriginal and Torres Strait Islander
patients
The regression model (including records of
both Aboriginal and Torres Strait Islander
and non-Aboriginal and Torres Strait Islander
patients) with outcome factor ‘Aboriginal
and Torres Strait Islander status recorded’
is presented in Table 3. Prior recording of
Aboriginal and Torres Strait Islander status
was significantly associated with older patient
age and the patient being Aboriginal and
Torres Strait Islander. Patients who were new
to the practice or new to the registrar were
significantly less likely to have had their status
recorded previously.
For patients of Aboriginal and Torres Strait
Islander background, the univariable
findings of association of status recording are
presented in Table 2 and the multivariable
model is presented in Table 3. Of Aboriginal
and Torres Strait Islander patients, 82.0%
(96 of 117 [95%CI: 73.9-88.5]) had their
status documented prior to the encounter.
Aboriginal and Torres Strait Islander patients
attending a doctor at a larger practice size (6
or more GPs) were significantly less likely (OR
of 0.15 [95%CI: 0.04-0.65]) to have their status
recorded prior to that visit.
Compared to patients attending practices in
major cities, patients attending practices in
inner regional areas were more likely to have
their status recorded prior to the consultation.
However, the increased odds of patients in
outer regional and remote areas (compared
to major cities) having their status recorded
did not reach statistical significance.
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Aboriginal and Torres Strait Islander Status recorded
No (n=4,539)
Yes (n=5,165)
pb
0.004
816 (48%)
881 (52%)
Imputation analyses
There were missing data of 25.8% for the
outcome variable. In the imputation analyses
(see Supplementary Table 1, available
online) for all patients (Aboriginal and
Torres Strait Islander and non-Aboriginal
and Torres Strait Islander patients), the
same variables remained in the model. All
significant variables remained significant.
The non-significant finding of bulk-billing
practices being more likely to have status
recorded became statistically significant, as
did recording in outer regional/remote/very
remote locations.
In records of Aboriginal and Torres Strait
Islander patients only (examining our
secondary outcome), NESB dropped out of
the imputed multivariable model.
Discussion
Summary of main findings
Patients were found to have their Aboriginal
and Torres Strait Islander status documented
prior to the consultation in 53.2% of
encounters. Associations of recording of
status were older patients, Aboriginal and
Torres Strait Islander patients and the patient
not being new to the practice.
Of the Aboriginal and Torres Strait Islander
patients in this study, four in five were found
to have their status documented prior to
the encounter. In this smaller number of
consultations, the only significant association
of recording of status was size of practice,
with those attending larger practices less
likely to have their status recorded.
Australian and New Zealand Journal of Public Health
© 2015 The Authors
Vol. 40 (Suppl. 1) 2016
General practice recording of Aboriginal and Torres Strait Islander status
Strengths and limitations
A major strength of our study is the high
response rate, with 94.7% of registrars
participating, and the conduct of the
study across four Australian states and
all ASGC-RS classifications. This response
rate is exceptional for studies of general
practitioners.22 While the response rate is
high, there was 25.8% missing data for the
outcome variable. For the primary analysis;
however, use of multiple imputation
techniques strongly supported the findings of
our analysis.
Another strength of the study is the faceto-face orientation of the ReCEnT project,
including orientation to best practice
in asking Aboriginal and Torres Strait
Islander status.18 We are thus confident
Table 2: Characteristics associated with recording the patient’s Aboriginal and Torres Strait Islander status for
Aboriginal and Torres Strait Islander patients (n=117a).
Variable
Patient age group
Aboriginal and Torres Strait Islander Status recorded
No (n=21)
Yes (n=96)
pb
0.46
26 (76%)
8 (24%)
Class
<15
15 to <31
5 (14%)
30 (86%)
7 (21%)
26 (79%)
Patient gender
1 (6.7%)
11 (28%)
14 (93%)
29 (73%)
0.057
Non-English Speaking Background
Female
No
10 (13%)
19 (17%)
66 (87%)
91 (83%)
0.15 (Exact)
New patient to the registrar
Yes
No
2 (50%)
9 (15%)
2 (50%)
51 (85%)
0.34
New patient to surgery
Yes
No
12 (22%)
18 (18%)
43 (78%)
84 (82%)
0.72 (Exact)
Practice sizec
Yes
Small
3 (21%)
3 (6.1%)
11 (79%)
46 (94%)
0.004
Does the practice routinely bulk billd
Large
No
18 (27%)
19 (22%)
49 (73%)
67 (78%)
0.051
Rurality
Yes
Major city
2 (6.5%)
9 (17%)
29 (94%)
44 (83%)
0.92
Inner regional
8 (20%)
32 (80%)
Outer regional/Remote/Very remote
mean (SD)
4 (17%)
5.6 (2.1)
20 (83%)
5.3 (2.6)
SEIFA Index (decile)
0.64
a: Numbers may not add to 117 due to missing data
b: Logistic regression adjusted for clustering
c: Practices defined as small if less than 6 GPs were working in the practice
d: Practices were defined as routinely bulk-billing if all patients were routinely bulk-billed.
Table 3: Results of Multivariable analyses.
Univariable
Variable
Adjusted for other variables
in the model
OR (95% CI)
P
Class
OR (95% CI)
P
Predictors of recording the patient’s Aboriginal and Torres Strait Islander status (all patients)
1.11 (1.01–1.22)
0.032
1.11 (1.01–1.21)
Patient age group
15 to <31
0.037
1.11 (1.01–1.22)
0.037
Referent age <15
31 to <55
1.13 (1.03–1.24)
0.008
0.004
1.18 (1.06–1.32)
<.001
1.22 (1.10–1.36)
55+
Aboriginal or Torres Strait Islander Yes
2.64 (1.74–4.01)
<.001
3.09 (1.91–5.00)
<0.001
New patient to the registrar
Yes
0.82 (0.75–0.89)
<.001
0.89 (0.82–0.97)
0.007
New patient to surgery
Yes
0.51 (0.42–0.62)
<.001
0.53 (0.43–0.64)
<0.001
Does the practice routinely bulk bill Yes
1.91 (1.08–3.35)
0.025
1.79 (0.96–3.34)
0.068
Rurality
Inner regional
1.96 (1.21–3.17)
0.006
2.06 (1.22–3.48)
0.007
Referent Major City
Outer regional/
1.51 (0.77–2.96)
0.23
1.68 (0.79–3.58)
0.18
Remote/Very remote
Predictors of recording the patient’s Aboriginal and Torres Strait Islander status for Aboriginal and Torres Strait Islander patients
Patient gender
Female
2.50 (0.96–6.55)
0.061
2.19 (0.77–6.27)
0.14
Non-English Speaking Background No
4.79 (0.63–36.15) 0.15 (Exact) 9.59 (0.97–95.17) 0.050 (Exact)
Practice size
Large
0.18 (0.05–0.64)
0.009
0.15 (0.04–0.65)
0.011
Does the practice routinely bulk bill Yes
4.11 (0.9–18.82)
0.068
4.81 (0.75–31.06)
0.099
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A potential limitation is that while there is
excellent generalisability to Australian GP
practices that train registrars, these practices
may differ from non-training practices. A
further limitation is that while the findings
of the primary analysis regarding the
associations of recording Aboriginal and
Torres Strait Islander status in the full practice
population are robust, interpretation of
the associations of recording in Indigenous
patients is limited by the smaller sample size.
Comparison with existing literature
and interpretation of findings
55+
Male
31 to <55
of the reliability of data for this important
independent variable (the Aboriginal and
Torres Strait Islander status of each patient).
The percentage of patients in mainstream
general practice in our study who identified
as Aboriginal or Torres Strait Islander (1.2%) is
broadly consistent with previously published
data.15,23
To our knowledge, this is the first
time prevalence and associations of
documentation of Aboriginal and Torres Strait
Islander status in the clinic record has been
described in the general practice setting
(the setting of a substantial proportion of
Aboriginal and Torres Strait Islander health
care delivery). As a result, there is no literature
with which to compare our prevalence of
53.2% documentation of status.
We found a strong positive association
between recording of Aboriginal and Torres
Strait Islander status and the patient being
Aboriginal and Torres Strait Islander. This has
not been described before and may reflect
patients self-identifying to their GP.
Our finding of 82% of Aboriginal and Torres
Strait Islander patients having had their status
recorded in the general practice clinical file
is comparable with hospital findings from
the Australian Institute of Health and Welfare
(AIHW). In hospitals, 88% of Aboriginal and
Torres Strait Islander patients were found to
be correctly identified on admission records.10
The same report found that the percentage
of Aboriginal and Torres Strait Islander
patients correctly identified increased with
remoteness. Although we found that there
was an increased recording of status for
patients in inner regional areas compared
to major cities, this association was not
statistically significant for outer regional,
remote and very remote areas. When we
examined only Aboriginal and Torres Strait
Islander patients, there was no difference in
recording of status by degree of rurality.
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Thomson et al.
The proportion of patients new to the
practice with status recorded in our study was
33.4% (see Table 1). Previous literature has
suggested that only one-third of practices
had methods in place to routinely collect
Aboriginal or Torres Strait Islander status for
new patients.9 General practice staff have
previously described that identification of
Aboriginal and Torres Strait Islander status
in new patients would be easier than in
pre-existing patients.9 Our findings suggest
that although it may be perceived as easier,
actual recording of new patients’ Aboriginal
and Torres Strait Islander status is relatively
infrequent.
Implications for practice and policy
We found that younger patient age was
associated with less recording of Aboriginal
and Torres Strait Islander status. This may
suggest that Aboriginal and Torres Strait
Islander status is not being routinely and
systematically recorded in the clinical record
by practices. An interpretation is that status
tends to be recorded not systematically but,
rather, only when a condition associated with
Aboriginal and Torres Strait Islander status
(especially a chronic condition, for example
diabetes) develops. However, for the clinician,
knowing the Aboriginal and Torres Strait
Islander status of a child is just as important
as knowing the status of an adult, e.g. in the
management of otitis media.24 Our findings
should encourage clinicians to especially
consider asking and recording the Aboriginal
and Torres Strait Islander status of younger
patients in their practice.
Patients attending practices in inner regional
locations had almost twice the odds of having
their status recorded than those in major
cities. Given that 32% of Aboriginal and Torres
Strait Islander people live in urban areas,25
our findings suggest there is an imperative to
improve recording in major cities.
This study took place after changes were
made to general practice accreditation,
making collection and recording of Aboriginal
and Torres Strait Islander status on all patients
(regardless of ethnic background) a standard
for practice accreditation.5 Our findings –
that nearly half the clinical records did not
have Aboriginal and Torres Strait Islander
health status documented, and that nearly
20% of Aboriginal and Torres Strait Islander
patients remained unidentified – suggest
that further work remains to be done. Best
practice guidelines regarding identification
of Aboriginal and Torres Strait Islander status
in general practice recommend a systems-
S74
based approach to identification.9 This
includes questions about Aboriginal and
Torres Strait Islander status as part of new
patient registration information.9 Our findings
regarding new patients to the surgery being
less likely to be recorded suggest that this is
not occurring at a practice level, or at least
status is not being entered into the file prior
to the clinician seeing the patient. This is
consistent with the contention that ensuring
all patients are asked about Aboriginal and
Torres Strait Islander status “cannot easily be
centrally mandated or enforced.”1
It is perhaps encouraging that the majority
of Aboriginal and Torres Strait Islander
patients were recorded in the clinical record.
However, given the importance of this to
the individual patient, and that just under
20% of patients who identify as Aboriginal or
Torres Strait Islander did not have their status
recorded, there is still considerable room for
improvement on this important public health
issue. Promotion and education around the
importance of the issue and implementation
of best practice guidelines2 is imperative for
policy makers and practitioners alike. Our
findings suggest increased attention be given
to recording the status of young patients and
new patients, and improving recording in
practices in urban locations.
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Supporting Information
Additional supporting information may be
found in the online version of this article:
Supplementary Table 1: Results of analyses
including imputed data.
Australian and New Zealand Journal of Public Health
© 2015 The Authors
Vol. 40 (Suppl. 1) 2016