A controlled trial to improve delivery of preventive care: physician or patient reminders?

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.

A prospective, controlled trial of five-months' duration.

A university hospital-based, general medical clinic.

Thirty-nine junior and senior medical residents who saw patients in stable clinic teams throughout the study.

A computerized reminder system for physicians and a patient questionnaire and educational hand-out on preventive care.

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.

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.