Improving preventive care by prompting physicians

Objectives: To assess the impact of prompting physicians on health maintena nce, answer questions regarding the mode of delivery, and identify opportun ities and limitations of this information intervention. Methods: Systematic electronic and manual searches (January 1, 1966, to Dec ember 31, 1996) were conducted to identify clinical trial reports on prompt ing clinicians. Three eligibility criteria were applied: (1) randomized con trolled clinical trial, (2) clinician prompt, alert, or reminder in the stu dy group and no similar intervention in the control group, and (3) measurem ent of the intervention effect on the frequency of preventive care procedur es. Data were abstracted by independent reviewers using a standardized abst raction form, and quality of methodology was scored. A series of meta-analy ses on triggering clinical actions was performed using the random-effects m ethod. The statistical analyses included 33 eligible studies, which involve d 1547 clinicians and 54 693 patients. Results: Overall, prompting can significantly increase preventive care perf ormance by 13.1% (95% confidence interval [CI], 10.5%-15.6%). However, the effect ranges from 5.8% (95% CI, 1.5%-10.1%) for Papanicolaou smear to 18.3 % (95% CI, 11.6%-25.1%) for influenza vaccination. The effect is not cumula tive, and the length of intervention period did not show correlation with e ffect size (R = -0.015, P = .47). Academic affiliation, ratio of residents, and technique of delivery did not have a significant impact on the clinica l effect of prompting. Conclusions: Dependable performance improvement in preventive care can be a ccomplished through prompting physicians. Vigorous application of this simp le and effective information intervention could save thousands of lives ann ually. Health care organizations could effectively use prompts, alerts, or reminders to provide information to clinicians when patient care decisions are made.