Access to cervical screening in Australian general practices: a cross-sectional study using a ‘secret shopper’ approach

Abstract

Purpose Cervical screening in Australia is currently accessed through a healthcare provider, typically a general practitioner in primary care. We aimed to assess the real-world availability of and access to cervical screening services, including self-collection. Methods Cross-sectional study was conducted using a secret shopper methodology with a standardized telephone script that emulated real-life calls. A random sample of Australian general practices, from each State/Territory (contacted November 2024-February 2025). Results Of the 310 general practices, 72 (23%) could not offer a cervical screening appointment for new patients. Among practices able to provide an appointment, 217 (89%) said self-collection was available. By jurisdiction, the proportion of practices reporting availability of cervical screening ranged from 72 to 83% but did not significantly differ. The proportion of clinics that offered the choice of self-collection differed significantly by State/Territory ( $$\chi_{7}^{2}$$ χ 7 2 =15·774, P = ·013), ranging from 60 to 100%. More regional clinics (94%) offered self-collection compared to metropolitan clinics (85%)( P = ·017). Practices located in the most disadvantaged socioeconomic quintile had a significantly higher proportion offering self-collection (95%) compared to those located in the most advantaged quintile (79%)( P = ·043). Out-of-pocket or gap fees were charged by 183 (75%) clinics (average: $AU50·73, range $AU15-$94·15). Conclusion Our study highlighted that access to cervical screening may be constrained by limited appointments for new patients, out-of-pocket costs, and other factors. These barriers may disproportionately affect individuals facing structural and financial disadvantage. We found significant variability in availability of self-collection by location. Exploring flexible models, including mail-out, pharmacy supported, or community-led models, may improve accessibility and reduce burden on general practices.

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