title: Randomized controlled trial of health maintenance reminders provided directly to patients through an electronic PHR.
abstract: BACKGROUND
  Provider and patient reminders can be effective in increasing rates of preventive screenings and vaccinations. However, the effect of patient-directed electronic reminders is understudied.
  
  
  OBJECTIVE
  To determine whether providing reminders directly to patients via an electronic Personal Health Record (PHR) improved adherence to care recommendations.
  
  
  METHODS
  We conducted a cluster randomized trial without blinding from 2005 to 2007 at 11 primary care practices in the Partners HealthCare system.
  
  
  METHODS
  A total of 21,533 patients with access to a PHR were invited to the study, and 3,979 (18.5%) consented to enroll.
  
  
  METHODS
  Patients in the intervention arm received health maintenance (HM) reminders via a secure PHR "eJournal," which allowed them to review and update HM and family history information. Patients in the active control arm received access to an eJournal that allowed them to input and review information related to medications, allergies and diabetes management.
  
  
  METHODS
  The primary outcome measure was adherence to guideline-based care recommendations.
  
  
  RESULTS
  Intention-to-treat analysis showed that patients in the intervention arm were significantly more likely to receive mammography (48.6% vs 29.5%, p = 0.006) and influenza vaccinations (22.0% vs 14.0%, p = 0.018). No significant improvement was observed in rates of other screenings. Although Pap smear completion rates were higher in the intervention arm (41.0% vs 10.4%, p < 0.001), this finding was no longer significant after excluding women's health clinics. Additional on-treatment analysis showed significant increases in mammography (p = 0.019) and influenza vaccination (p = 0.015) for intervention arm patients who opened an eJournal compared to control arm patients, but no differences for any measure among patients who did not open an eJournal.
  
  
  CONCLUSIONS
  Providing patients with HM reminders via a PHR may be effective in improving some elements of preventive care.
authors: Brigham & Women's Hospital, Boston, MA 02115, USA. awright5@partners.org
authors: Adam
authors: A
authors: Wright
authors: Eric G
authors: EG
authors: Poon
authors: Jonathan
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authors: Wald
authors: Joshua
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authors: Feblowitz
authors: Justine E
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authors: Pang
authors: Jeffrey L
authors: JL
authors: Schnipper
authors: Richard W
authors: RW
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authors: Tejal K
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authors: Lynn A
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authors: Volk
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authors: Bloom
authors: Deborah H
authors: DH
authors: Williams
authors: Kate
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authors: Gardner
authors: Marianna
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authors: Epstein
authors: Lisa
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authors: Nelson
authors: Alex
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authors: Businger
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authors: David W
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authors: Bates
authors: Blackford
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authors: Middleton
mesh_terms: D000328:Adult; D005260:Female; D015438:Health Behavior; D055991:Health Records, Personal; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D017010:Reminder Systems / Q000592:standards