The Link Between Primary Health Care and Health Outcomes for Aboriginal and Torres Strait Islander Australians

Audit for Best practice in Chronic Disease (ABCD)

This review explores the evidence both domestically and internationally as to whether access to high quality primary health care is essential to enhancing Indigenous health status.

Page last updated: June 2008

The ABCD program is a continuous quality improvement (CQI) approach to improving chronic disease detection and management in Aboriginal primary health care services. It began in 2002 with twelve community health centres (both Government-run and community controlled) across the Top End of the Northern Territory; in 2006, it received additional funding from the Cooperative Research Centre for Aboriginal Health (CRCAH) and is being to extended to over 70 health centres in the Northern Territory, Queensland, New South Wales and Western Australia.

The ABCD program works with health centres to improve the delivery of care using a structured and collaborative approach to assess clinical performance against best practice guidelines. It also works to improve health centre systems that are needed to support best practice, such as clear staff roles and responsibilities, data and clinical management systems, and the availability of best-practice guidelines.

While long term positive health outcomes are yet to be documented, the evaluation report for the twelve initial communities found that over the first three years of the program participating health centres improved their levels of evidenced-based care, and interim health outcomes (in particular for diabetics) also improved.

The main limiting factor on improvements seemed to be failure of systems for follow up and adequate treatment, largely because of the pressure of acute care needs in the primary health care setting. Participation of doctors as part of the primary health care team is an important factor for success.

Measures

  • Systems development:
- improvements systems to support chronic illness care
  • Processes of care
- improvement in proportion of scheduled diabetes services delivered from 30% to 52%
- improvement in proportion of diabetics with a record of a BP check within 3 months from 63% to 76% - improvement in proportion of diabetics with a record of an HbA1c check within 6 months from 41% to 72%Top of page
  • Intermediate outcomes of care
- improvement in proportion of diabetics whose most recent HbA1c check was <7% from 19% to 28%;
- improvement in proportion of diabetics whose most recent total cholesterol was <4.0mmol/L from 23% to 30%.

Contributing factors
  • Systems development:
- improvements systems to support chronic illness care
  • Processes of care:
- improvement in proportion of scheduled diabetes services delivered from 30% to 52%
- improvement in proportion of diabetics with a record of a BP check within 3 months from 63% to 76%
- improvement in proportion of diabetics with a record of an HbA1c check within 6 months from 41% to 72%
  • Intermediate outcomes of care:
- improvement in proportion of diabetics whose most recent HbA1c check was <7% from 19% to 28%;
- improvement in proportion of diabetics whose most recent total cholesterol was <4.0mmol/L from 23% to 30%.