Abstract
BackgroundEarly onset and high prevalence of chronic disease among Indigenous Australians call for action on prevention. However, there is deficiency of information on the extent to which preventive services are delivered in Indigenous communities. This study examined the variation in quality of preventive care for well adults attending Indigenous community health centres in Australia.MethodsDuring 2005-2009, clinical audits were conducted on a random sample (stratified by age and sex) of records of adults with no known chronic disease in 62 Indigenous community health centres in four Australian States/Territories (sample size 1839). Main outcome measures: i) adherence to delivery of guideline-scheduled services within the previous 24 months, including basic measurements, laboratory investigations, oral health checks, and brief intervention on lifestyle modification; and ii) follow-up of abnormal findings.ResultsOverall delivery of guideline-scheduled preventive services varied widely between health centres (range 5-74%). Documentation of abnormal blood pressure reading ([greater than or equal to]140/90 mmHg), proteinuria and abnormal blood glucose ([greater than or equal to]5.5 mmol/L) was found to range between 0 and > 90% at the health centre level. A similarly wide range was found between health centres for documented follow up check/test or management plan for people documented to have an abnormal clinical finding. Health centre level characteristics explained 13-47% of variation in documented preventive care, and the remaining variation was explained by client level characteristics.ConclusionsThere is substantial room to improve preventive care for well adults in Indigenous primary care settings. Understanding of health centre and client level factors affecting variation in the care should assist clinicians, managers and policy makers to develop strategies to improve quality of preventive care in Indigenous communities.
Highlights
Onset and high prevalence of chronic disease among Indigenous Australians call for action on prevention
Studies conducted in the Northern Territory (NT) have documented substantial deficiencies in delivery of preventive care to Indigenous adults in rural and remote communities: on average only 40-50% of preventive services were delivered in line with the best practice guidelines [5,6]
This paper reports baseline data on delivery of preventive care in Indigenous community health centres participating in ABCDE with a focus on variation in quality of care between services and across different participating regions, and identifies the various factors associated with these variations, both at the health centre level and at the individual level
Summary
Onset and high prevalence of chronic disease among Indigenous Australians call for action on prevention. As part of the response to high levels of chronic disease among Indigenous Australians[1], there has been increasing emphasis in recent years on delivery of preventive services in Indigenous primary health care services. This includes development and distribution of evidence-based, Indigenous population specific preventive care guidelines [2], introduction of Medicare reimbursed biennial health checks for Indigenous adults aged 15 years or over [3], and the newly released National Preventative Health Strategy which specifies targets and actions for multifaceted preventive care to “close the gap” in life expectancy between Indigenous and other Australians [4].
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