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There is emerging evidence that taking basic measurements and screening of patients are done relatively well (such as taking a patient’s blood pressure or ordering tests), but the adequacy of follow up is less well-documented in patient records (Bailie et al. 2014, 2017). Failure to follow up abnormal test results is an important patient safety issue and requires urgent attention. Improving follow up of abnormal results has been identified as a top priority by healthcare practitioners, managers and policymakers working in Indigenous primary healthcare services (PHS) (Matthews et al. 2015; Bailie et al. 2016, 2017). In a recent study, we presented aggregated continuous quality improvement data from 123 Indigenous PHS (6523 patient records) for chronic illness care and asked stakeholders in diverse roles and organisations to identify what they regarded as the priority evidence-practice gaps (Matthews et al. 2015). Data showed that some aspects of chronic illness care were being provided and documented at high levels by health centres, such as measurement of weight, blood pressure, glycated haemoglobin (HbA1c) and ordering of tests (Matthews et al. 2015). However, PHS performance in many aspects of care is suboptimal, with wide variation between health centres. The highest ranked priority, as identified by over 200 stakeholders, was to improve the delivery and documentation of follow-up care when there is an abnormal test result (notably HbA1c, total cholesterol : high-density lipoprotein (HDL) ratio, and blood pressure) (Matthews et al. 2015). As a case-in-point, we present findings for follow up of abnormal blood pressure results below.

Rigorous follow-up systems for abnormal results are essential to improve health outcomes for Aboriginal and Torres Strait Islander people