A controlled trial to improve delivery of preventive care
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
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 handout 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.
- Breslow L, Somers AR. The lifetime health-monitoring program: a practical approach to preventive medicine. N Engl J Med. 1977;296:601–8. CrossRef
- American Cancer Society. Guidelins for the cancer-related checkup: recommendations and rationale. CA. 1980;30:193–240.
- Spitzer WO, chairman. Report of the task force on the periodic health examination. Can Med Assoc J. 1979;121:1193–254.
- Dietrich AJ, Goldberg H. Preventive content of adult primary care: do generalists and subspecialists differ? Am J Public Health. 1984;74:223–7. CrossRef
- Battista RN, Palmer CS, Marchand BM, Spitzer WO. Patterns of preventive practice in New Brunswick. Can Med Assoc J. 1985;132:1013–5.
- Romm FJ, Fletcher SW, Hulka BS. The periodic health examination: comparison of recommendations and internists’ performance. South Med J. 1981;74:265–71.
- Lynch GR, Prout MN. Screening for cancer by residents in an internal medicine program. J Med Educ. 1986;61:387–93.
- Turner BJ, Day SC, Griffith JA, McLellan AT. Factors influencing preventive health care in a general medical clinic. Clin Res. 1984;32:657A (abstract).
- Cohen DI, Littenberg B, Wetzel C, Neuhauser DvB. Improving physician compliance with preventive medicine guidelines. Med Care. 1982;20:1040–5. CrossRef
- Siegal S. Non-parametric statistics for the behavioral sciences. New York: McGraw-Hill, 1956;75–83.
- Winer BJ, Statistical principles in experimental design. 2nd ed. New York: McGraw-Hill, 1971;781–96.
- Rodney WM, Chopivsky P, Quan M. Adult immunization: the medical record design as a facilitator for physician compliance. J Med Educ. 1983;58:576–80.
- Wayland MT, Culik D, Goldsby C, Carion W, Orzame N. Screening by family practice and internal medicine residents and the effect of an intervention program. J Med Educ. 1987;62:519–22.
- McDonald CJ, Hui SL, Smith DM, Tierney WM, et al. Reminders to physicians from an introspective computer medical record: a two-year randomized trial. Ann Intern Med. 1984;100:130–8.
- Davidson RA, Fletcher SW, Retchin S, Duh S. A nurse-initiated reminder system for the periodic health examination: implementation and evaluation. Arch Intern Med. 1984;144:2167–70. CrossRef
- Cheney C, Ramsdell JW. Effect of medical records’ checklists on implementation of periodic health measures. Am J Med. 1987;83:129–36. CrossRef
- Larson EB, Bergman J, Heidrich F, Alvin BL, Schneeweiss R. Do postcard reminders improve influenza vaccination compliance? A prospective trial of different postcard “cues”. Med Care. 1982;20:639–48. CrossRef
- Thompson RS, Michnich ME, Gray J, Friedlander L, Gilson B. Maximizing compliance with Hemoccult screening for colon cancer in clinical practice. Med Care. 1986;24:904–14. CrossRef
- Brownlee HJ, Brown DL, D’Angelo RJ. Utilization of pneumococcal vaccine in a family practice residency. J Fam Pract. 1982;11:1111–4.
- A controlled trial to improve delivery of preventive care
Journal of General Internal Medicine
Volume 4, Issue 5 , pp 403-409
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Preventive care
- computer reminder
- patient questionnaire
- medical clinic
- Industry Sectors
- Author Affiliations
- 1. the Department of Medicine and the Center for Research for Medical Education and Health Care, Thomas Jefferson University, Jefferson Medical College, USA
- 2. the American Board of Internal Medicine and the Department of Medicine, University of Pennsylvania School of Medicine, USA