title: The delivery of preventive care to clients of community health services.
abstract: BACKGROUND
  Smoking, poor nutrition, risky alcohol use, and physical inactivity are the primary behavioral risks for common causes of mortality and morbidity. Evidence and guidelines support routine clinician delivery of preventive care. Limited evidence describes the level delivered in community health settings. The objective was to determine the: prevalence of preventive care provided by community health clinicians; association between client and service characteristics and receipt of care; and acceptability of care. This will assist in informing interventions that facilitate adoption of opportunistic preventive care delivery to all clients.
  
  
  METHODS
  In 2009 and 2010 a telephone survey was undertaken of 1284 clients across a network of 56 public community health facilities in one health district in New South Wales, Australia. The survey assessed receipt of preventive care (assessment, brief advice, and referral/follow-up) regarding smoking, inadequate fruit and vegetable consumption, alcohol overconsumption, and physical inactivity; and acceptability of care.
  
  
  RESULTS
  Care was most frequently reported for smoking (assessment: 59.9%, brief advice: 61.7%, and offer of referral to a telephone service: 4.5%) and least frequently for inadequate fruit or vegetable consumption (27.0%, 20.0% and 0.9% respectively). Sixteen percent reported assessment for all risks, 16.2% received brief advice for all risks, and 0.6% were offered a specific referral for all risks. The following were associated with increased care: diabetes services, number of appointments, being male, Aboriginal, unemployed, and socio-economically disadvantaged. Acceptability of preventive care was high (76.0%-95.3%).
  
  
  CONCLUSIONS
  Despite strong client support, preventive care was not provided opportunistically to all, and was preferentially provided to select groups. This suggests a need for practice change strategies to enhance preventive care provision to achieve adherence to clinical guidelines.
authors: Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287, Australia. Kathleen.McElwaine@hnehealth.nsw.gov.au
authors: Kathleen M
authors: KM
authors: McElwaine
authors: Megan
authors: M
authors: Freund
authors: Elizabeth M
authors: EM
authors: Campbell
authors: Jenny
authors: J
authors: Knight
authors: Jennifer A
authors: JA
authors: Bowman
authors: Emma L
authors: EL
authors: Doherty
authors: Paula M
authors: PM
authors: Wye
authors: Luke
authors: L
authors: Wolfenden
authors: Christophe
authors: C
authors: Lecathelinais
authors: Scott
authors: S
authors: McLachlan
authors: John H
authors: JH
authors: Wiggers
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000706:statistics & numerical data*; D003695:Delivery of Health Care; D004032:Diet / Q000592:standards; D005260:Female; D005638:Fruit; D015438:Health Behavior; D006303:Health Services, Indigenous / Q000592:standards; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000592:standards*; D012307:Risk Factors; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D014675:Vegetables
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