Randomized controlled trial of a computer strategy to increase general practitioner preventive care

Background Previous interventions targeting primary care practitioners with the aim of increasing preventive care delivery have demonstrated limited e ffectiveness. The primary aim of this study was to assess the effectiveness of a computerized continuing medical education program to increase rates o f three screening behaviors (cholesterol, blood pressure, and cervical scre ening) and to identify three risk behaviors (smoking, alcohol consumption, benzodiazepine use) in general practice. Methods. Nineteen general practitioners were randomly allocated to interven tion or control conditions. Those given the intervention received a compute rized feedback system. The intervention was delivered using a touchscreen c omputer located in the surgery waiting area. The preventive behaviors of in terest were patient smoking, alcohol use, benzodiazepine use, and blood pre ssure, cholesterol and cervical screening using the Papanicolou test. Diffe rences in performance by group in each of the outcomes was measured at base line and 3-month follow-up. Logistic regression analyses with generalized e stimating equations were conducted as the main analyses. Result. At 3-month follow-up, statistically significant differences were ev ident in the following outcome measures: accurate classification of benzodi azepine users (z = 2.8540, P < 0.05); accurate classification of non-benzod iazepine users (z = 2.7339, P < 0.05); accurate classification of hazardous or harmful alcohol drinkers (z = 2.3079, P < 0.02); blood pressure screeni ng (z = 3.4136, P < 0.001); and cholesterol screening (z = 6.6313, P<0.001) , Conclusion. A computerized system of performance-specific feedback was effe ctive at increasing some preventive care services in general practice. (C) 1999 American Health Foundation and Academic Press.