REQUIRING PHYSICIANS TO RESPOND TO COMPUTERIZED REMINDERS IMPROVES THEIR COMPLIANCE WITH PREVENTIVE CARE PROTOCOLS

被引：181

作者：

LITZELMAN, DK

DITTUS, RS

MILLER, ME

TIERNEY, WM

机构：

[1] Regenstrief Institute for Health Care, Indianapolis, 46202, IN, 5th Floor

来源：

JOURNAL OF GENERAL INTERNAL MEDICINE | 1993年 / 8卷 / 06期

关键词：

CANCER SCREENING; CANCER PREVENTION; COMPUTER REMINDERS; PHYSICIAN COMPLIANCE; GERIATRICS;

D O I：

10.1007/BF02600144

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Objective: To improve compliance with computer-generated reminders to perform fecal occult blood testing (FOBT), mammography, and cervical Papanicolaou (Pap) testing. Design: Six-month prospective, randomized, controlled trial. Setting: Academic primary care general internal medicine practice. Subjects: Thirty-one general internal medicine faculty, 145 residents, and 5,407 patients with scheduled visits who were eligible for any of the three cancer screening protocols. Intervention: Primary care teams of internal medicine residents and faculty received either routine computer reminders (control) or the same reminders to which they were required to circle one of four responses: 1) ''done/order today,'' 2) ''not applicable to this patient, '' 3) '' patient refused, '' or 4) '' next visit. '' Results: Intervention physicians complied more frequently than control physicians with all reminders combined (46% vs 38%, respectively, p = 0.002) and separately with reminders for FOBT (61% vs 49%, p = 0.0007) and mammography (54% vs 47%, p = 0.036) but not cervical Pap testing (2 1% vs 18%, p = 0.2). Intervention residents responded significantly more often than control residents to all reminders together and separately to reminders for FOBT and mammography but not Pap testing. There was no significant difference between intervention and control faculty, but the compliance rate for control faculty was significantly higher than the rate for control residents for all reminders together and separately for FOBT but not mammography or Pap testing. The intervention's effect was greatest for patients greater-than-or-equal-to 70 years old, with significant results for all tests, together and singly, for residents but not faculty. Intervention physicians felt that the reminders were not applicable 21% of the time (due to inadequate data in patients' electronic medical records) and stated that their patients refused 10% of the time. Conclusions: Requiring physicians to respond to computer-generated reminders improved their compliance with preventive care protocols, especially for elderly patients for whom control physicians' compliance was the lowest. However, 100% compliance with cancer screening reminders will be unattainable due to incomplete data and patient refusal.

引用

页码：311 / 317

页数：7

共 29 条

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