title: Changing clinical practice through patient specific reminders available at the time of the clinical encounter: systematic review and meta-analysis.
abstract: OBJECTIVE
  To synthesise current evidence for the influence on clinical behaviour of patient-specific electronically generated reminders available at the time of the clinical encounter.
  
  
  METHODS
  PubMed, Cochrane library of systematic reviews; Science Citation Index Expanded; Social Sciences Citation Index; ASSIA; EMBASE; CINAHL; DARE; HMIC were searched for relevant articles.
  
  
  METHODS
  We included controlled trials of reminder interventions if the intervention was: directed at clinician behaviour; available during the clinical encounter; computer generated (including computer generated paper-based reminders); and generated by patient-specific (rather than condition specific or drug specific) data.
  
  
  METHODS
  Systematic review and meta-analysis of controlled trials published since 1970. A random effects model was used to derive a pooled odds ratio for adherence to recommended care or achievement of target outcome. Subgroups were examined based on area of care and study design. Odds ratios were derived for each sub-group. We examined the designs, settings and other features of reminders looking for factors associated with a consistent effect.
  
  
  RESULTS
  Altogether, 42 papers met the inclusion criteria. The studies were of variable quality and some were affected by unit of analysis errors due to a failure to account for clustering. An overall odds ratio of 1.79 [95% confidence interval 1.56, 2.05] in favour of reminders was derived. Heterogeneity was high and factors predicting effect size were difficult to identify.
  
  
  CONCLUSIONS
  Methodological diversity added to statistical heterogeneity as an obstacle to meta-analysis. The quality of included studies was variable and in some reports procedural details were lacking.
  
  
  CONCLUSIONS
  The analysis suggests a moderate effect of electronically generated, individually tailored reminders on clinician behaviour during the clinical encounter. Future research should concentrate on identifying the features of reminder interventions most likely to result in the target behaviour.
authors.affiliation: Department of Primary Care Health Sciences, University of Oxford, 2nd floor, 23-38 Hythe Bridge Street, Oxford, OX1 2ET, UK. tim.holt@phc.ox.ac.uk
authors.forename: Tim A
authors.initials: TA
authors.lastname: Holt
authors.forename: Margaret
authors.initials: M
authors.lastname: Thorogood
authors.forename: Frances
authors.initials: F
authors.lastname: Griffiths
mesh_terms: D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000639:trends; D017010:Reminder Systems / Q000639:trends; D013813:Therapy, Computer-Assisted / Q000379:methods* / Q000639:trends; D013997:Time Factors