title: Effectiveness of computerized point-of-care reminders on adherence with multiple clinical recommendations by primary health care providers: protocol for a cluster-randomized controlled trial.
abstract: BACKGROUND
  To determine the effectiveness of reminders compared to no reminders in improving adherence to multiple clinical recommendations measured as the resolution of the clinical condition that motivated the reminder, in a primary care setting with a well-established feedback system.
  
  
  METHODS
  A 12-month, cluster-randomized, controlled clinical trial was designed (randomized by primary care team) to evaluate the impact of computerized reminders. All study participants will continue to receive the usual feedback from the electronic health records system. The control group (well-established feedback) will be compared with reminders and a well-established feedback system. The study will include all general practitioners (3425) and nurses (3262) providing primary care for a population aged 14 years or older in the 282 primary care teams reporting to the Catalan Institute of Health. Up to 10 clinical reminders are offered for each patient, recommending action related to at least one of nine clinical conditions: arterial hypertension, elevated cardiovascular risk, type 2 diabetes mellitus, cerebrovascular accident, ischemic heart disease, heart failure, atrial fibrillation, smoking habit, and hepatitis C. The outcomes are the resolution of the clinical condition that motivated the reminder and the time elapsed between the first reminder message and implementation of the recommended action (months). Due to the obvious correlation between reminders about the same patient, the profile of patients assigned to a particular professional, and the professionals assigned to a particular centre, hierarchical modelling will be used to simultaneously estimate the effect of the study variables at these different levels of analysis. To estimate the impact of the intervention arm, an analysis of adherence to each type of reminder will be carried out, using multi-level logistical regression models at level of the primary care centre. Time to adherence will be estimated by the Kaplan-Meier method and comparisons will be done using the log-rank test.
  
  
  CONCLUSIONS
  The results of this study could provide new evidence on the impact of computerized reminders at the point of care on adherence to clinical guidelines in primary care with an established feedback system. Trial registration ISRCTN42391639. October 8, 2012.
authors.affiliation: Sistemes d'Informació d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia Spain.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Méndez Boo
authors.affiliation: Sistemes d'Informació d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia Spain.
authors.forename: Ermengol
authors.initials: E
authors.lastname: Coma
authors.affiliation: Sistemes d'Informació d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Medina
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, 08007 Barcelona, Catalonia Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Hermosilla
authors.affiliation: Oficina Projecte ECAP, Centre de competència funcional, Institut Català de la Salut, Barcelona, Catalonia Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Iglesias
authors.affiliation: Oficina Projecte ECAP, Centre de competència funcional, Institut Català de la Salut, Barcelona, Catalonia Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Olmos
authors.affiliation: Àrea de Desenvolupament Clínic, Institut Català de la Salut, Barcelona, Spain.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Calero Muñoz
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, 08007 Barcelona, Catalonia Spain.
authors.forename: Johanna
authors.initials: J
authors.lastname: Caro Mendivelso
keywords: Electronic health record; Primary health care; Quality of health care; Reminder systems