A patient-initiated system for preventive health care. A randomized trial in community-based primary care practices

Abstract

Objective: To test the effectiveness of a patient-initiated, touch-sensitive computer system (TSCS) for improving screening rates for cancers of the breast, cervix, colon and rectum, and oral cavity.

Design: One-year, randomized, controlled trial with primary care practice as the unit of analysis.

Setting: Sixty primary care practices, randomly recruited from 329 nonteaching practices in a southeastern state.

Subjects: Random sample of the medical records of 50 male and female adult patients before intervention and 50 adult patients after intervention in each practice and a random sample of 507 TSCS users.

Interventions: Touch-sensitive computer system and a registered nurse who served as liaison to the study practices. The TSCS provided patient-specific preventive service recommendations and facilitated work flow to increase the completion of these interventions.

Main outcome measure: Average change, adjusted for health maintenance examination (HME) and use of the TSCS, in the proportion of eligible patients undergoing screening mammography, clinical breast examination, digital rectal examination, fecal occult blood test, flexible sigmoidoscopy, Papanicolaou smear, and oral cavity examination.

Results: We observed a significant increase in the completion of screening mammography (6.6%; P < or = 0.5) and clinical breast examination (6.1%; P < or = .01) in women 50 years of age and older, particularly for those who had an HME during the study year.

Conclusions: Patients who have HMEs are more likely to receive cancer screening; however, a computer-based system for preventive services can contribute to improvement in screening. Among those patients who did not have an HME, TSCS users had higher rates of breast cancer screening than nonusers.