title: Requiring physicians to respond to computerized reminders improves their compliance with preventive care protocols.
abstract: OBJECTIVE
  To improve compliance with computer-generated reminders to perform fecal occult blood testing (FOBT), mammography, and cervical Papanicolaou (Pap) testing.
  
  
  METHODS
  Six-month prospective, randomized, controlled trial.
  
  
  METHODS
  Academic primary care general internal medicine practice.
  
  
  METHODS
  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.
  
  
  METHODS
  Primary care teams of internal medicine residents and faculty received either routine computer reminders (control) or the same remainders 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 remainders combined (46% vs 38%, respectively, p = 0.002) and separately with remainders 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 > or = 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 patient's 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 remainders will be unattainable due to incomplete data and patient refusal.
authors.affiliation: Regenstrief Institute for Health Care, Department of Medicine, Indiana University School of Medicine, IN 46202.
authors.forename: D K
authors.initials: DK
authors.lastname: Litzelman
authors.forename: R S
authors.initials: RS
authors.lastname: Dittus
authors.forename: M E
authors.initials: ME
authors.lastname: Miller
authors.forename: W M
authors.initials: WM
authors.lastname: Tierney
mesh_terms: D000328:Adult; D000368:Aged; D005194:Family Practice / Q000193:education; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D008297:Male; D008327:Mammography; D008875:Middle Aged; D009780:Occult Blood; D065006:Papanicolaou Test; D011314:Preventive Health Services; D011446:Prospective Studies; D017010:Reminder Systems; D014626:Vaginal Smears