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JAMIA 2008;15:311-320 doi:10.1197/jamia.M2555
  • The Practice of Informatics
  • Review Paper

Prompting Clinicians about Preventive Care Measures: A Systematic Review of Randomized Controlled Trials

  1. Judith W Dexheimera,
  2. Thomas R Talbotb,c,
  3. David L Sandersa,
  4. S Trent Rosenblooma,c,
  5. Dominik Aronskya,d
  1. aDepartment of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
  2. bDepartment of Preventive Medicine, Vanderbilt University Medical Center, Nashville, TN
  3. cDepartment of Medicine, Vanderbilt University Medical Center, Nashville, TN
  4. dDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
  1. Correspondence: Dominik Aronsky, MD, PhD, Department of Biomedical Informatics, Eskind Biomedical Library, Vanderbilt University, 2209 Garland Ave, Nashville, TN 37232-8340 (e-mail: <dominik.aronsky{at}vanderbilt.edu>)
  • Received 12 July 2007
  • Accepted 29 January 2008

Abstract

Preventive care measures remain underutilized despite recommendations to increase their use. The objective of this review was to examine the characteristics, types, and effects of paper- and computer-based interventions for preventive care measures. The study provides an update to a previous systematic review. We included randomized controlled trials that implemented a physician reminder and measured the effects on the frequency of providing preventive care. Of the 1,535 articles identified, 28 met inclusion criteria and were combined with the 33 studies from the previous review. The studies involved 264 preventive care interventions, 4,638 clinicians and 144,605 patients. Implementation strategies included combined paper-based with computer generated reminders in 34 studies (56%), paper-based reminders in 19 studies (31%), and fully computerized reminders in 8 studies (13%). The average increase for the three strategies in delivering preventive care measures ranged between 12% and 14%. Cardiac care and smoking cessation reminders were most effective. Computer-generated prompts were the most commonly implemented reminders. Clinician reminders are a successful approach for increasing the rates of delivering preventive care; however, their effectiveness remains modest. Despite increased implementation of electronic health records, randomized controlled trials evaluating computerized reminder systems are infrequent.

Footnotes

  • JWD was supported by training grant from the National Library of Medicine (LM T15 007450-03). STR was supported by a National Library of Medicine grant (LM K22 08576-02).

  • Preliminary results from this work were presented at the 2005 AMIA Annual Symposium (ref: Dexheimer JW, Sanders DL, Rosenbloom ST, Aronsky D. Prompting clinicians: a systematic review of preventive care reminders. AMIA Annu Symp Proc. 2005;:938.)

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