Table 6.

Key findings and considerations for policy, practice, and research.

Key findings	Considerations for policy, practice, and research
Variation between aspects of care and key opportunities for improvement	Use CQI processes to identify and address priority areas for improvement (15)
	Use strategies or design options at various system levels to enhance delivery of priority aspects of preventive care, with a focus on addressing specific barriers at the patient, health center, regional, and policy levels
	Evaluate and refine CQI processes and other strategies to maximize suitability and effectiveness in different contexts
	Possible areas for specific focus include
	− Review appointment systems, walk-in arrangements and work flow in clinics to maximize opportunities for health assessments and preventive care (30)
	− Design processes to enable completion of health assessments over successive visits
	− Allocate specific time for completion of health assessments (31)
	− Provide training on priority aspects of preventive care for individuals and teams (7)
	− Review and clarify roles and responsibilities of health teams with regard to health assessments and preventive care
	− Provide decision support for completion of all recommended preventive services (32)
	− Consider design of gender specific services to meet local needs, including development of gender specific health worker roles
	− Use outreach to workplaces and family or other groups when appropriate to deliver health assessments and enhance preventive care for priority hard-to-reach groups
	− Support research to identify and address specific barriers to preventive care
Low levels of follow-up of identified risk factors and abnormal clinical and laboratory findings	Use CQI processes to identify and address priority areas for improvement in follow-up care
	Use strategies or design options at various system levels to enhance follow-up, with a focus on addressing specific barriers at the patient, health center, regional and policy levels
	Possible areas for specific focus include
	− Development of incentives or removal of barriers at the policy level – for example increased financial incentives for effective follow-up, or reducing the number of recommended preventive services to focus effort on ensuring follow-up (31)
	− Consider incentives and barriers at health service, community and patient level, for example cost and availability of health services, and of transport (30, 31)
	− Encourage effective use of clinical information systems to enhance follow-up, including clear documentation of planning and delivery of follow-up care (31) and provision of appropriate decision support
	− Consider how development and implementation of models of patient-centered care could enhance follow-up care
	− Ensure individual staff and health teams understand the importance of follow-up care
	− Support research to identify and address specific barriers to follow-up
Variation between health centers	Use CQI processes to monitor and address variation between health centers/districts/regions in delivery of preventive care, with an emphasis on enhancing delivery in health centers/districts/regions at the lower end of the range
	Possible areas for specific focus in understanding and enhancing preventive care in health centers/districts/regions at the lower end of the range
	− Support research to understand barriers and development and implementation of strategies to address variation
	− Support effectiveness of information technology and sharing of clinical information, including developing staff capability and improving user friendliness of clinical information systems in these health centers/districts/regions
	− Implement appropriate redesign and re-allocation of resources – including but not restricted to staff resources such as Aboriginal Health Practitioners, allied health professionals
	− Consider how organizational management and culture could be developed to enhance service delivery in these health centers/districts/regions
	− Consider how structure, function, skills and knowledge base of health teams could be developed specifically to enhance service delivery in these health centers/districts/regions
	− Explore how challenges of staff recruitment and retention, and provision of expert and experienced decision support could be implemented specifically to enhance service delivery in these health centers/districts/regions
	− Enhance opportunities for high performing services to share their systems and approach to care with those services with less well developed care delivery