Improving compliance with preventive medicine procedures in a house staff training program

Performance of health maintenance procedures by internal medicine house staff is inadequate, yet little has been published outlining means to improve performance rates. We prospectively studied the effectiveness of a reminder system to improve screening by Pap smear, rectal examination with stool guaiac test, breast examination, and pneumococcal vaccine administration in two resident outpatient clinics. Performance of these preventive health measures was determined during a six-week baseline period and again after five months of chart reminders to residents in one clinic, and after six months without reminders. For the intervention, a physician's assistant screened each chart and attached a reminder to the front indicating which procedures were overdue based on published recommendations. Health screening behavior was not significantly different between the two resident clinics during baseline. After the five-month reminder intervention, residents in both groups moderately increased their preventive health activities over baseline; however, only the reminded group showed significant improvement (chi 2 = 11.60, P less than .001). Six months after remainders were discontinued there was no difference in overall performance between the two clinics (chi 2 = 2.79, NS). The reminded group did preserve its significant improvement over the baseline phase (chi 2 = 6.12, P less than .01). This simple reminder system had a modest but statistically significant positive impact on health screening behavior. Despite this improvement, absolute rates of screening remained below 50% in both clinics.