Delivery of preventive health services to Indigenous adults: response to a systems-oriented primary care quality improvement intervention
Delivery of preventive health services to Indigenous adults: response to a systems-oriented primary care quality improvement intervention
复制标题
DOI：
10.5694/j.1326-5377.2007.tb01356.x
复制
发表时间：
2007-10-15
影响因子：
11.4
通讯作者：
Weeramanthri, Tarun S.
中科院分区：
文献类型：
--
作者：
Si, Damin;Bailie, Ross S.;Weeramanthri, Tarun S.
目的：描述与系统导向干预相关的土著社区成人预防服务提供的变化。设计、环境和参与者：2002年1月至2005年12月期间，在北领地的12个土著社区保健中心开展了一项质量改进干预措施，并进行了为期2年的随访。该研究涉及360名年龄在16-49岁之间的健康成年人，他们没有已知的慢性疾病诊断。干预：每年两个周期的评估、反馈研讨会、行动计划和系统变更的实施。评估包括对卫生服务系统进行结构化审查和对临床记录进行审计。主要结果措施：遵守指南规定的预防服务，包括进行基本测量、实验室检查、生活方式咨询和肺炎球菌疫苗接种。结果：在测量的12项预防服务中，4项服务的提供在研究期间有所改善：饮食咨询从3%增加到8% (P= 0.018)；体育活动咨询从2%到8% (P= 0.006)；吸烟咨询从2%降至11% (P= 0.003)；酒精咨询从2%到10% （P = 0.007）。在监测腰围、血压和血糖水平、肺炎球菌疫苗接种等重要措施上没有改善。结论：我们以系统为导向的干预与咨询活动的一些改善有关，但在提供其他预防服务方面没有显著改善。主要原因可能是实施更多地侧重于慢性病管理，而不是对一般健康的成年人的预防服务。
Objective: To describe changes in delivery of preventive services among adults in Aboriginal communities that occurred in association with a systems-oriented intervention.Design, setting and participants: A quality improvement intervention with a 2-year follow-up was undertaken at 12 Aboriginal community health centres in the Northern Territory between January 2002 and December 2005. The study involved 360 well adults aged 16-49 years who had no known diagnosis of chronic disease.Intervention: Two annual cycles of assessment, feedback workshops, action planning, and implementation of system changes. Assessment included a structured review of health service systems and an audit of clinical records.Main outcome measures: Adherence to guideline-scheduled preventive services including taking basic measurements, laboratory investigations, lifestyle counselling and pneumococcal vaccination.Results: Of 12 preventive services measured, delivery of four services showed improvement over the study period: counselling on diet increased from 3% to 8% (P= 0.018); counselling on physical activity from 2% to 8% (P= 0.006); counselling on smoking from 2% to 11 % (P= 0.003); and counselling on alcohol from 2% to 10% (P = 0.007). There was no improvement in important measures such as monitoring of waist circumference, blood pressure and blood glucose level, and delivery of pneumococcal vaccination.Conclusion: Our systems-oriented intervention was associated with some improvement in counselling activities, but no significant improvement in delivery of other preventive services. The main reason may be that implementation focused more on chronic illness management than preventive services for generally well adults.