Determinants and gaps in preventive care delivery for Indigenous Australians: a cross-sectional analysis

Bailie, Christopher, Matthews, Veronica, Bailie, Jodie, Burgess, Paul, Copley, Kerry, Kennedy, Catherine, Moore, Liz, Larkins, Sarah, Thompson, Sandra, and Bailie, Ross Stewart (2016) Determinants and gaps in preventive care delivery for Indigenous Australians: a cross-sectional analysis. Frontiers in Public Health, 4. 34. pp. 1-11.

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Abstract

Background: Potentially preventable chronic diseases are the greatest contributor to the health gap between Aboriginal and Torres Strait Islander peoples and non-­Indigenous Australians. Preventive care is important for earlier detection and control of chronic disease, and a number of recent policy initiatives have aimed to enhance delivery of preventive care. We examined documented delivery of recommended preventive services for Indigenous peoples across Australia and investigated the influence of health center and client level factors on adherence to best practice guidelines.

Methods: Clinical audit data from 2012 to 2014 for 3,623 well adult clients (aged 15–54) of 101 health centers from four Australian states and territories were analyzed to determine adherence to delivery of 26 recommended preventive services classified into five different modes of care on the basis of the way in which they are delivered (e.g., basic measurement; laboratory tests and imaging; assessment and brief interventions, eye, ear, and oral checks; follow-up of abnormal findings). Summary statistics were used to describe the delivery of each service item across jurisdictions. Multilevel regression models were used to quantify the variation in service delivery attributable to health center and client level factors and to identify factors associated with higher quality care.

Results: Delivery of recommended preventive care varied widely between service items, with good delivery of most basic measurements but poor follow-up of abnormal findings. Health center characteristics were associated with most variation. Higher quality care was associated with Northern Territory location, urban services, and smaller service population size. Client factors associated with higher quality care included age between 25 and 34 years, female sex, and more regular attendance.

Conclusion: Wide variation in documented preventive care delivery, poor follow-up of abnormal findings, and system factors that influence quality of care should be addressed through continuous quality improvement approaches that engage stakeholders at multiple levels (including, for example, access to care in the community, appropriate decision support for practitioners, and financial incentives and context appropriate guidelines).

Item ID: 43417
Item Type: Article (Research - C1)
ISSN: 2296-2565
Keywords: preventive healthcare, Aboriginal and Torres Strait Islander, variation, indigenous, quality of care, adherence to best practice guidelines
Additional Information:

© 2016 Bailie, Matthews, Bailie, Burgess, Copley, Kennedy, Moore, Larkins, Thompson and Bailie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

https://creativecommons.org/licenses/by/4.0/

Funders: National Health and Medical Research Council (NHMRC), Lowitja Institute (LI), Australian Research Council (ARC)
Projects and Grants: NHMRC 545267, ARC Future Fellowship 100100087
Date Deposited: 29 Jul 2016 05:20
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 50%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111701 Aboriginal and Torres Strait Islander Health @ 50%
SEO Codes: 92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920506 Rural Health @ 50%
92 HEALTH > 9203 Indigenous Health > 920303 Aboriginal and Torres Strait Islander Health - Health System Performance (incl. Effectiveness of Interventions) @ 50%
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