A controlled trial to improve delivery of preventive care: physician or patient reminders?

Abstract

Objective: To improve the delivery of preventive care in a medical clinic, a controlled trial was conducted of two interventions that were expected to influence delivery of preventive services differently, depending on level of initiative required of the physician or patient to complete a service.

Design: A prospective, controlled trial of five-months' duration.

Setting: A university hospital-based, general medical clinic.

Participants: Thirty-nine junior and senior medical residents who saw patients in stable clinic teams throughout the study.

Intervention: A computerized reminder system for physicians and a patient questionnaire and educational hand-out on preventive care.

Measurements and main results: Delivery of five of six audited preventive services improved significantly after the interventions were introduced. The computerized reminder alone increased completion rates of services that relied primarily on physician initiative; the questionnaire alone increased completion rate of the service that depended more on patient compliance as well as on some physician-dependent services. Both interventions used together were slightly less effective in improving performance of physician-dependent services than the computerized reminder used alone.

Conclusions: These interventions can improve the delivery of preventive care but they differ in their impacts on physician and patient behaviors. Overall, the computer reminder was the more effective intervention.