Improving preventive health care in Aboriginal and Torres Strait Islander primary care settings

Abstract

Background: Like other colonised populations, Indigenous Australians experience poorer health outcomes than non-Indigenous Australians. Preventable chronic disease is the largest contributor to the health differential between Indigenous and non-Indigenous Australians, but recommended best-practice preventive care is not consistently provided to Indigenous Australians. Significant improvement in health care delivery could be achieved through identifying and minimising evidence-practice gaps. Our objective was to use clinical audit data to create a framework of the priority evidence-practice gaps, strategies to address them, and drivers to support these strategies in the delivery of recommended preventive care.

Methods: De-identified preventive health clinical audit data from 137 primary health care (PHC) centres in five jurisdictions were analysed (n = 17,108 audited records of well adults with no documented major chronic disease; 367 system assessments; 2005-2014), together with stakeholder survey data relating to interpretation of these data, using a mixed-methods approach (n = 152 responses collated in 2015-16). Stakeholders surveyed included clinicians, managers, policy officers, continuous quality improvement (CQI) facilitators and academics. Priority evidence-practice gaps and associated barriers, enablers and strategies to address the gaps were identified and reported back through two-stages of consultation. Further analysis and interpretation of these data were used to develop a framework of strategies and drivers for health service improvement.

Results: Stakeholder identified priorities were: following-up abnormal test results; completing cardiovascular risk assessments; timely recording of results; recording enquiries about living conditions, family relationships and substance use; providing support for clients identified with emotional wellbeing risk; enhancing systems to enable team function and continuity of care. Drivers identified for improving care in these areas included: strong Indigenous participation in the PHC service; appropriate team structure and function to support preventive care; meaningful use of data to support quality of care and CQI; and corporate support functions and structures.

Conclusion: The framework should be useful for guiding development and implementation of barrier-driven, tailored interventions for primary health care service delivery and policy contexts, and for guiding further research. While specific strategies to improve the quality of preventive care need to be tailored to local context, these findings reinforce the requirement for multi-level action across the system. The framework and findings may be useful for similar purposes in other parts of the world, with appropriate attention to context in different locations.

Keywords: Aboriginal and Torres Strait Islander health; Preventive health care; Primary health care.

Fig. 1

Mean health centre record of plan for follow-up of abnormal blood pressure, blood glucose level and lipid profile, by audit year. Note: Lipid test was introduced into the preventive health audit tool in August 2010

Fig. 2

Mean health centre recording of cardiovascular risk assessment, by audit year. Note: This item was introduced into the preventive health audit tool in August 2010. According to best practice guidelines, clients eligible for absolute cardiovascular risk assessment if: Indigenous, ≥35 years of age and not a resident of the Northern Territory; or Indigenous, ≥20 years of age and a resident of the Northern Territory; or non-Indigenous and 45 years and over

Fig. 3

Mean health centre record of urinalysis and lipid profile, by audit year. Note: Lipid test was introduced into the preventive health audit tool in August 2010

Fig. 4

Mean health centre percentage of clients with record of enquiry regarding environmental and living conditions, family relationships and other substance use, by audit year. Note: These items were introduced into the preventive health audit tool in August 2010

Fig. 5

Mean health centre percentage of clients with a record of emotional wellbeing (EW) follow-up action if identified at risk using a standard tool, by audit year. Note: These indicators were introduced in the audit tool in August 2010 and apply to those clients that had a record of being at risk of an emotional wellbeing issue

Fig. 6

Team structure and function and continuity of care component scores, by audit year

Fig. 7

Mean health centre overall service delivery to well clients. Note: Overall preventive care service delivery composite figure includes: weight, waist circumference, blood pressure, urinalysis, blood glucose level, sexually transmitted infections (gonorrhoea and chlamydia; syphilis), pap smear, oral health, nutrition, physical activity, smoking and alcohol status recorded, brief intervention if smoker and/or high risk alcohol user

Fig. 8

Drivers of high quality preventive care and suggested strategies for addressing identified evidence-practice gaps