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Closing the gap: progress, but more effort needed

18 July 2017
Indigenous health in the spotlight

With some exceptions, primary health care is failing to deliver adequate preventive health care to Indigenous Australians who experience higher levels of ill health than non-Indigenous people, new research reveals.

The findings add to a catalogue of similar research findings and stand in the face of major health and Medicare programs that have sought to improve health outcomes in Indigenous Australians through better access to preventive health assessments and follow-up care by primary healthcare providers.

The latest findings, published by in Globalization and Health by Australian researchers, are based on an audit of 17,108 of health records of well adults seen at 137 primary health care centres in five states/territories between 2005 and 2014.

The good news is we saw improvements in some areas of preventive healthcare
Jodie Bailie, University of Sydney.

The audit examined whether best practice preventive health care assessments, such as blood pressure checks and heart health screening were recorded, and whether healthcare providers provided follow-up care based on health assessments findings.

Based on input from indigenous health stakeholders, the researchers made their conclusions by reviewing data in six priority areas: follow-up of abnormal blood pressure, heart health, urinalysis, blood lipids, enquiries about living conditions, and follow up of people at risk poor emotional well-being.

“The good news is we saw improvements in some areas of preventive healthcare,” said the paper’s lead author, Jodie Bailie of the University of Sydney.

“For example, we found more up to-date health summaries and immunisation records, increases in the measurement of weight and blood pressure, increased delivery of brief interventions for patients using high levels of alcohol, and better recording of Medicare numbers. Overall the delivery of preventive care in these areas has improved.  However, we saw a concerning ten per cent decline in follow up healthcare plans for patients with high blood pressure and a 25 per cent decline in follow up healthcare plans for patients with poor emotional well-being

“Also, there was wide variation between health centres in nearly all aspects of preventive care. This is due to failures or weakness in the wider health system. Some of the areas that need improving are the follow up of healthcare plans for patients with high blood pressure and follow up healthcare plans for patients with poor emotional well-being.”

“Furthermore, research shows that while screening, or health assessments, may increase new diagnoses, there is no evidence that they prevent hospitalisations or premature death. While reasons for the lack of impact of health assessments are not well understood, it’s clear that health assessments have limited potential to improve health outcomes in the absence of appropriate follow-up care.”

The research also identified key drivers to improve care. These include:

  • the need for strong Indigenous participation in the primary care service
  • systems to support the meaningful use of data to improve quality of care
  • further training and support to use clinical information systems.

Key findings

Overall delivery of preventive care

  • On average, 60 per cent of patients received best-practice preventive care (2014), an increase from 35 per cent since 2005.
  • However, there continues to be wide variation between health care providers (20 – 85 per cent)

Blood pressure checks

  • On average, only 20 per cent of patients with high blood pressure had a follow-up plan recorded in their health records (2014), a decline from 30 per cent since 2005.
  • There was wide variation among healthcare providers in recording the need for follow-up care: 2005: (0 – 60 per cent); 2014: (0 – 100 per cent)

Cardiovascular disease checks

  • On average, 40 per cent of patients received cardiovascular disease risk assessment (2014). This item was introduced into the preventive health audit tool in 2010 and the audit reveals that CVD risk assessments have risen between 2010-2014. 
  • However, the latest 2014 data shows wide variation between healthcare providers providing CVD risk assessments (0 – 85 per cent). 

Urinalysis

  • On average, 60 per cent of patients had urinalysis to check for the presence of several diseases (2014). This has risen since 2010 when 30 per cent of patients had urinalysis.
  • However, the latest 2014 data shows wide variation among healthcare providers providing urinalysis risk (0 – 100 per cent). 

Lipid profiles

  • On average, 55 per cent of patients had a lipid profile test to check the amount of “good” and “bad” cholesterol in blood (2014). This figure has risen from 35 per cent since 2010.
  • The latest 2014 data shows wide variation between healthcare providers providing a lipid profile test (10 – 90 per cent). 

Living conditions

  • On average, 40 per cent of patients were asked about their living conditions, family relationships and substance abuse (2014). This figure has risen from 14 per cent since 2010
  • The latest 2014 data shows wide variation between healthcare providers asking patients about their living conditions (0 – 90 per cent).

Emotional well-being

  • On average, 40 per cent of patients were screened for their emotional well-being (2014). This figure has fallen from 65 per cent since 2010.
  • The latest 2014 data shows wide variation between healthcare providers asking patients about their emotional well-being (0 – 100 per cent).
  • A minority of patients assessed as having poor emotional well-being had follow-up care such as counselling, behavior therapy or medications recorded in their health records.

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