Requiring physicians to respond to computerized reminders improves their compliance with preventive care protocols

Debra Litzelman, Robert S. Dittus, Michael E. Miller, William M. Tierney

Research output: Contribution to journalArticle

179 Citations (Scopus)

Abstract

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 (21% 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 ≥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.

Original languageEnglish
Pages (from-to)311-317
Number of pages7
JournalJournal of General Internal Medicine
Volume8
Issue number6
DOIs
StatePublished - Jun 1993

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Preventive Medicine
Physicians
Occult Blood
Mammography
Internal Medicine
Early Detection of Cancer
Primary Health Care
Electronic Health Records
Compliance
Randomized Controlled Trials

Keywords

  • cancer prevention
  • cancer screening
  • computer reminders
  • geriatrics
  • physician compliance

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Requiring physicians to respond to computerized reminders improves their compliance with preventive care protocols. / Litzelman, Debra; Dittus, Robert S.; Miller, Michael E.; Tierney, William M.

In: Journal of General Internal Medicine, Vol. 8, No. 6, 06.1993, p. 311-317.

Research output: Contribution to journalArticle

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abstract = "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 (21{\%} 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 ≥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.",
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