title: Preventive medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback.
abstract: BACKGROUND
  Interventions to improve delivery of preventive medical services have been shown to be effective in North America and the UK. However, there are few studies of the extent to which the impact of such interventions has been sustained, or of the impact of such interventions in disadvantaged populations or remote settings. This paper describes the trends in delivery of preventive medical services following a multifaceted intervention in remote community health centres in the Northern Territory of Australia.
  
  
  METHODS
  The intervention comprised the development and dissemination of best practice guidelines supported by an electronic client register, recall and reminder systems and associated staff training, and audit and feedback. Clinical records in seven community health centres were audited at regular intervals against best practice guidelines over a period of three years, with feedback of audit findings to health centre staff and management.
  
  
  RESULTS
  Levels of service delivery varied between services and between communities. There was an initial improvement in service levels for most services following the intervention, but improvements were in general not fully sustained over the three year period.
  
  
  CONCLUSIONS
  Improvements in service delivery are consistent with the international experience, although baseline and follow-up levels are in many cases higher than reported for comparable studies in North America and the UK. Sustainability of improvements may be achieved by institutionalisation of relevant work practices and enhanced health centre capacity.
authors.affiliation: Menzies School of Health Research, PO Box 41096 Casuarina NT 0811, Darwin, Australia. rossb@menzies.edu.au
authors.forename: Ross S
authors.initials: RS
authors.lastname: Bailie
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Togni
authors.forename: Damin
authors.initials: D
authors.lastname: Si
authors.forename: Gary
authors.initials: G
authors.lastname: Robinson
authors.forename: Peter H N
authors.initials: PH
authors.lastname: d'Abbs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019985:Benchmarking; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D003695:Delivery of Health Care / Q000639:trends*; D005246:Feedback; D006303:Health Services, Indigenous / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007256:Information Systems; D007318:Inservice Training; D008485:Medical Audit; D008875:Middle Aged; D015876:Northern Territory; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D011785:Quality Assurance, Health Care; D012042:Registries; D017010:Reminder Systems