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Biomedical subjects

W W Rosser

Publications and source records attributed to W W Rosser.

16 recordsLinked to original sources
PubMed1992

Use of reminders to increase compliance with tetanus booster vaccination.

OBJECTIVE: To assess the effect of three computerized reminder systems on compliance with tetanus vaccination. DESIGN: Prospective randomized controlled trial. SETTING: Ottawa Civic Hospital Family Medicine Centre. PARTICIPANTS: Of 8069 patients 20 years of age or more who were not in a hospital or institution 5589 were randomly assigned, by family, to a control group, a physician reminder group, a telephone reminder group or a letter reminder group. The remaining 2480 patients were not included in the randomized portion of the study but were monitored. Results are presented for the 5242 randomized patients and the 2369 nonrandomized patients for whom there was no up-to-date record of tetanus vaccination at the start of the trial. INTERVENTIONS: For the patients in the physician reminder group the physician was reminded at an office visit to assess the patient's tetanus vaccination status and to recommend vaccination; those in the other two reminder groups received a telephone call or letter enquiring about their tetanus vaccination status and recommending a booster dose. MAIN OUTCOME MEASURE: Proportion of patients who received tetanus toxoid during the study year or who had a claim of vaccination in the previous 10 years. MAIN RESULTS: The rate of recorded tetanus vaccination in the randomized control group was 3.2%. The difference between that rate and those for the three reminder groups was 19.6% in the physician reminder group (95% confidence interval [CI] 17.1% to 22.2%, p less than 0.00001), 20.8% in the telephone reminder group (95% CI 18.3% to 23.5%, p less than 0.00001) and 27.4% in the letter reminder group (95% CI 24.8% to 30.2%, p less than 0.00001)). The letter reminders were more effective than either the telephone reminders (p = 0.00013) or the physician reminders (p less than 0.00001) in improving compliance. The cost to the practice per additional vaccination recorded was 43 for the physician reminders, $5.43 for the telephone reminders and $6.05 for the letter reminders. CONCLUSIONS: Although all three reminder systems increased the rate of recorded tetanus vaccination they fell far short of achieving complete population coverage. More intensive interventions would be required to approach that goal. However, such interventions do not appear to be justified given the rarity of tetanus.

Adult↗
PubMed1991

Use of reminders for preventive procedures in family medicine.

OBJECTIVE: To compare the effectiveness of three computerized reminder systems in the delivery of five preventive procedures in family practice. DESIGN: Prospective, randomized, controlled study. SETTING: Ottawa Civic Hospital Family Medicine Centre. PARTICIPANTS: Of 8502 patients 15 years of age or more who were not in a hospital or institution 5883 were randomly assigned, by family, to a control group, a physician reminder group (passive) or a telephone or letter reminder group (active). The remaining 2619 patients were not included in the randomized portion of the study but were monitored. INTERVENTION: During 1 year the patients in the active reminder groups received a telephone call or letter reminding them of any overdue preventive procedures; for those in the passive reminder group the physician was reminded at an office visit to provide any overdue service. OUTCOME MEASURE: Rates of completion of the preventive procedures required. MAIN RESULTS: All three reminder systems significantly improved the delivery of preventive services (p less than 0.001). The procedure completion rates were 42.0% in the letter reminder group, 42.0% in the telephone reminder group, 33.7% in the physician reminder group and 14.1% in the randomized control group. The use of a letter was more cost-effective than the telephone system, but the physician reminder system was the most cost-effective. CONCLUSION: Computerized reminder systems do improve the delivery of preventive services in family practice.

Adolescent↗
PubMed1991

Clinical research.

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Community Medicine↗
PubMed1990

Do our patients receive maximum benefit from preventive care? A North American perspective.

Politicians, their constituents and family physicians believe that preventive medicine is essential if health care is to be improved. Family physicians believe that the majority of their patients are well cared for with preventive health care services but in reality preventive services are provided to less than half the population and some to fewer than 10%. Barriers to providing preventive care include the selection of procedures of unproven effectiveness, public unawareness of the benefits of the procedure and practical obstacles for physicians providing the services. Assessment of each of these barriers indicates how preventive care can be improved. Narrowing the gap between what we believe about preventive care and the level of preventive services we are providing could improve the health of our nations. However, the concept of primum non nocere must dominate the assessment of currently advocated preventive procedures and the consideration of new procedures.

Attitude of Health Personnel↗
PubMed1987

Bubonic plague.

Explore the source record for details and available documents.

Animals↗
PubMed1986

Computerization of family practice.

The primary focus of computer systems for family practice is on patient billing. Primary care physicians should be aware of the many other benefits that can and should be considered when planning a system for their practice. This article describes the type and extent of information that can be stored in a family practice data base and explores some of the applications in areas of practice and patient management, prevention and research.

Electronic Data Processing↗
PubMed1979

An evaluation system for an undergraduate clerkship in family medicine.

In 1970, all final year medical students at the University of Ottawa were required to complete a four-week clerkship in family medicine. The original evaluation system being used consisted of an ongoing assessment by the students' preceptor and a terminal test. This method was unsatisfactory, resulting in four new criteria for the terminal test being established: (1) that it be objective, reproducible, and reliable; (2) that it assess attitudes toward the patient; (3) that it be flexible and not rigidly structured; and (4) that it simulate actual family practice as closely as possible. A new preceptor's evaluation form was also developed. With annual assessment of the evaluation method since 1973, numberous modifications have been introduced to meet the criteria originally sought. Use of a mark sense data entry system and packaged analysis programs have facilitated ongoing evaluation of the system. Currently the preceptor's evaluation form meets both educational and assessment requirements, and the terminal tests meet the criteria developed in 1971.

Curriculum↗
PubMed1978

Screening in family medicine: the current situation.

Unrealistic patient expectations, financial constraints, and lack of medical scientific evidence as to the benefits of screening make it difficult for the family physician to establish appropriate screening procedures in his/her practice. The current status of screening is reviewed and some suggestions are made as to how family physicians might better use what is known about screening.

Adult↗