title: Determinants and Gaps in Preventive Care Delivery for Indigenous Australians: A Cross-sectional Analysis.
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.
  
  
  CONCLUSIONS
  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).
authors.affiliation: School of Medicine, University of Queensland , Brisbane, QLD , Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bailie
authors.affiliation: Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia.
authors.forename: Veronica
authors.initials: V
authors.lastname: Matthews
authors.affiliation: Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia.
authors.forename: Jodie
authors.initials: J
authors.lastname: Bailie
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Primary Health Care Branch, Top End Health Service, Northern Territory Government, Darwin, NT, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Burgess
authors.affiliation: Aboriginal Medical Services Alliance NT (AMSANT) , Darwin, NT , Australia.
authors.forename: Kerry
authors.initials: K
authors.lastname: Copley
authors.affiliation: Maari Ma Health Aboriginal Corporation , Broken Hill, NSW , Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kennedy
authors.affiliation: Aboriginal Medical Services Alliance NT (AMSANT) , Darwin, NT , Australia.
authors.forename: Liz
authors.initials: L
authors.lastname: Moore
authors.affiliation: College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia; Anton Breinl Research Centre for Health Systems Strengthening, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Larkins
authors.affiliation: Western Australian Centre for Rural Health, School of Primary, Aboriginal and Rural Health Care, University of Western Australia , Geraldton, WA , Australia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Thompson
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; School of Population Health, University of Queensland, Brisbane, QLD, Australia.
authors.forename: Ross Stewart
authors.initials: RS
authors.lastname: Bailie
keywords: Aboriginal and Torres Strait Islander; adherence to best practice guidelines; indigenous; preventive healthcare; quality of care; variation