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PubMed1992

Implementing clinical guidelines: a quality management approach to reminder systems.

"Reminders" (timely notices about specific clinical events to physicians or patients) are useful strategies for implementing clinical guidelines. These systems can vary widely in content, design, and purpose. This variability makes it difficult to compare systems or predict a reminder's efficacy in a particular setting. In this article, the authors suggest that too much attention has been paid to proving the efficacy of reminder systems as a general strategy or a comprehensive solution. Rather, the usefulness and effectiveness of reminder systems will be better appreciated when quality management principles are applied to designing, implementing, and maintaining them. Physicians must participate in finding the best solutions for clinical process problems, and reminder systems--when implemented as the "best solution"--must be monitored and improved continually on an ongoing basis to continue to meet physicians' needs.

Feedback↗

PubMed2005

Improving patient compliance with best practices guidelines: a web based automated and personalized reminders system.

Health Reminders is a prototype application that delivers personalized guidelines and recommended testing to the patient at the appropriate time and through multiple communication channels such as email, web, cellular text messaging (Simplified Message Service), automatic insertion into Personal Information Managers (schedulers like MS Outlook) as appointments and tasks.

Humans↗

PubMed1980

Identification of potentially noncompliant patients with a mailed medication refill reminder system.

A medication refill reminder system was evaluated as a tool for identifying noncompliant patients. The system anticipates the date that a fully compliant patient would be expected to exhaust his or her medication supply and sends postcard reminders to all who have not obtained refills by the anticipated date. This refill reminder system has been in operation at the Pioneer Medical Center since 1973. During a 1-month study period, responses to the postcard reminders were monitored closely. Patients failing to respond within 5 days were contacted by telephone. The status of each patient's medication supply at the time of the pharmacy visit or telephone call was determined. Of 121 anticipated medication refill visits, 49 patients were found to have refilled their medications on or before the anticipated date. Reminder postcards were mailed to 72 patients. Within 5 days, 46 patients responded. Telephone calls were placed to 24 out of 25 patients. Two types of noncompliant behavior were identified; 34 out of 70 patients exhausted their medication supply before returning for a refill and 25 out of 70 patients accumulated a 1- to 30-day excess medication supply because of omitted doses. The postcard medication refill reminder system was found to be an effective tool for identifying patients who may benefit from compliance counseling with the pharmacist.

Community Health Centers↗

PubMed2000

Comparing assessment of appropriateness of diagnostic tests between a human expert and an automated reminder system.

This paper describes the validation of the GRIF automated reminder system. The reminder system has been developed to influence diagnostic test ordering of General Practitioners (GPs). It generates critical comments on the basis of accepted guidelines. A retrospective random selection of 253 request forms has been taken. We compared the comments of a human expert to the comments of the reminder system. A panel of two independent reviewers judged the requested tests based on the strict interpretation of the guidelines. The sensitivity, specificity and 'predictive values' of the comments of the reminder system and the human expert were calculated using the judgement of the two reviewers as 'gold standard'.

Artificial Intelligence↗

PubMed1996

The effectiveness of a mail reminder system for depot medroxyprogesterone injections.

To determine if a mail reminder system leads to an increase in the percentage of depot medroxyprogesterone acetate (Depo-Provera) injections administered on time, the charts of 184 women were reviewed. The reminder postcard included the due dates of both the next medroxyprogesterone injection and the next Papanicolaou test. Timeliness of injections improved with the reminder system from 64% administered on time to 76% (P < .02). Injections given late despite the reminders were late a mean of 8 days. Injections given late before the reminder system began were late a mean of 20 days (P < .05). If injections given during the injection's 14-day "grace" period are included, the on-time rate improved from 87% to 96% with the reminder system (P < .005). The reminder system was not effective in ensuring annual Papanicolaou testing. Vigilance is needed to ensure that women receiving medroxyprogesterone injections also receive timely Papanicolaou testing.

Adult↗

PubMed2003

Drivers' assessment of Ford's belt reminder system.

In recent model years, Ford vehicles have been equipped with a supplementary seat belt reminder system that flashes and chimes intermittently for up to 5 min if the driver is unbelted. Sound- and light-based belt reminder systems of various types are beginning to appear in the market place, and it is important to learn about their acceptance and ability to increase belt use. The present study was designed to ascertain consumer reaction and reported belt use regarding the Ford system. Personal interviews were conducted with 405 drivers of vehicles with the reminder system. Among the drivers, 67% said they had activated the belt reminder one or more times, 73% said that the last time this happened they fastened their belts, 46% said their belt use had increased since driving this vehicle, 78% said they liked the reminder system, and 79% said they wanted a reminder system like this in their next vehicle. Five percent had disabled the system. Part-time users were responsive to the reminder, for example, of those who said they currently used belts usually but not on some occasions, 70% said they fastened their seat belts the last time the reminder was activated and 76% said their belt use had increased. Five percent spontaneously mentioned the belt reminder as an especially disliked feature of their new vehicles, and 2% said their belt use had decreased since having it. The 7% of respondents who reported they used belts never or very occasionally were least responsive to the system. Overall, the Ford belt reminder system is being favorably received.

Accidents, Traffic↗

PubMedDate not supplied

A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting.

OBJECTIVE: Computer-based reminder systems have the potential to change physician and patient behaviors and to improve patient outcomes. We performed a meta-analysis of published randomized controlled trials to assess the overall effectiveness of computer-based reminder systems in ambulatory settings directed at preventive care. DESIGN: Meta-analysis. SEARCH STRATEGY: Searches of the Medline (1966-1994), Nursing and Allied Health (1982-1994), and Health Planning and Administration (1975-1994) databases identified 16 randomized, controlled trials of computer-based reminder systems in ambulatory settings. STATISTICAL METHODS: A weighted mixed effects model regression analysis was used to estimate intervention effects for computer and manual reminder systems for six classes of preventive practices. MAIN OUTCOME MEASURE: Adjusted odds ratio for preventive practices. RESULTS: Computer reminders improved preventive practices compared with the control condition for vaccinations (adjusted odds ratio [OR] 3.09; 95% confidence interval [CI] 2.39-4.00), breast cancer screening (OR 1.88; 95% CI 1.44-2.45), colorectal cancer screening (OR 2.25; 95% CI 1.74-2.91), and cardiovascular risk reduction (OR 2.01; 95% CI 1.55-2.61) but not cervical cancer screening (OR 1.15; 95% CI 0.89-1.49) or other preventive care (OR 1.02; 95% CI 0.79-1.32). For all six classes of preventive practices combined the adjusted OR was 1.77 (95% CI 1.38-2.27). CONCLUSION: Evidence from randomized controlled studies supports the effectiveness of data-driven computer-based reminder systems to improve prevention services in the ambulatory care setting.

Ambulatory Care↗

PubMedDate not supplied

The Cancer Prevention Reminder System.

The Cancer Prevention Reminder System is a computer-based system designed to increase the delivery of periodic health maintenance procedures. The program provides printed reminders that identify patients' overdue procedures, prints summary reports of the percentage of patients who are eligible and overdue for a procedure, and prints mailing labels for patients. We performed a randomized, controlled trial in which the effects of computer-based reminders were compared with those of two other interventions among residents in a university-based group practice.

Ambulatory Care Information Systems↗

PubMedDate not supplied

Use of a clinician reminder system for screening mammography in a public health clinic.

Physician reminder systems have been used to increase the appropriate use of clinical preventive services. These systems, though, have been typically tested in resident clinics. We conducted this study, using a time-series design, to determine if a manual clinician reminder system could increase the use of screening mammography in an urban public health clinic. In the one-year baseline period, 47% of women who were due for a mammogram received the procedure; the corresponding percentage in the one-year intervention period was 72% (P < .0000001). The improvement reflected a large increase in appropriate ordering behavior by primary care providers rather than an increase in patient adherence. This study demonstrates that a noncomputerized reminder system can greatly improve the delivery of screening mammography in a public health clinic setting.

Adult↗

PubMed1995

A computer-generated reminder system improves physician compliance with diabetes preventive care guidelines.

Computerized reminder systems have been shown to be effective in improving physician compliance with preventive services guidelines. Very little has been published about the use of computerized reminders for preventive care in diabetes. We implemented a computer-generated reminder system for diabetes care guidelines in a randomized controlled study in the outpatient clinics of 35 internal medicine residents at the University of Utah and Salt Lake Veterans Affairs Hospitals. After a six month study period, compliance with the recommended care significantly improved in both the intervention group that received patient-specific reminders about the guidelines (38.0% at baseline, 54.9% at follow-up) and the control group that received a nonspecific report (34.6% at baseline, 51.0% at follow-up). There was no significant difference between the two groups. Both clinic sites showed similar improvement over baseline levels of compliance. Residents who completed encounter forms used by the system showed a significantly greater improvement in compliance than those who did not complete encounter forms (19.7% vs. 7.6%, p = 0.006). The improvements in guideline compliance were seen in all areas of diabetes preventive care studied, and significant improvements were seen with recommended items from the medical history, physical exam, laboratory testing, referrals, and patient education. The use of encounter forms by the providers significantly improved documented compliance with the guidelines in almost all categories of preventive care. These results suggest that computerized reminder systems improve compliance with recommended care more by facilitating the documentation of clinical findings and the ordering of recommended procedures than by providing the clinician with patient-specific information about guideline compliance status. Further study is needed to understand the implications of these findings to the development of future computerized reminder systems for chronic diseases such as diabetes.

Analysis of Variance↗

PubMed2001

Validation of a knowledge based reminder system for diagnostic test ordering in general practice.

We describe the validation of a real-time automated reminder system that assists General Practitioners (GP) in appropriate test ordering. We compared the comments of human experts with the comments of the reminder system using a retrospective random selection of 253 request forms. A panel of three expert physicians judged the requested tests independently based on their interpretations of the practice guidelines. The majority assessment of the physicians was compared with the assessment of the reminder system. In case the system's output differed from the majority assessment the written practice guidelines were consulted. On average 1.75 reminders were produced per form. In total 32 of the 442 given reminders (7%) were given incorrectly. The amount of information and the level of detail (the specificity of the terms) in which the GP describes the patients' medical status are crucial for the reminder system to react correctly.

Adult↗

PubMed2006

ACOG committee opinion #329. Tracking and reminder systems.

An accurate and effective tracking or reminder system is useful for the modern practice of obstetrics and gynecology. It is not adequate to rely solely on the patient to complete all ordered studies and to follow up on physician recommendations. Obstetrician-gynecologists have an obligation to their patients to encourage them to complete studies believed essential for patient care within an acceptable time frame. Each office should establish a simple, reliable tracking and reminder system to improve patient safety and quality of care and to minimize missed diagnoses.

Appointments and Schedules↗

PubMed2002

Effectiveness of Ford's belt reminder system in increasing seat belt use.

OBJECTIVES: The study investigated the effectiveness in increasing seat belt use of Ford's belt reminder system, a supplementary system that provides intermittent flashing lights and chimes for five minutes if drivers are not belted. METHODS: Seat belt use of drivers in relatively new cars with and without the reminder system was unobtrusively observed as vehicles were brought to dealerships for service. RESULTS: Overall use rates were estimated at 71% for drivers in vehicles without the reminder system and 76% for drivers in vehicles with belt reminders (p<0.01). CONCLUSIONS: Seat belt use is relatively low in the United States. The present study showed that vehicle based reminder systems can be at least modestly effective in increasing belt use, which may encourage further development of such systems.

Automobile Driving↗

PubMed2004

The effect of a computerized reminder system on the prevention of postoperative venous thromboembolism.

STUDY OBJECTIVE: To measure the effect of an altered process of care, directed by a computerized reminder system, on rates of symptomatic postoperative venous thromboembolism. DESIGN: Comparisons of preintervention and postintervention measurements. SETTING: A university-affiliated community hospital in Utah. PATIENTS: Two-thousand seventy-seven consecutive patients who underwent major operations in four surgical divisions between January 1, 1997, and October 31, 1997 (preintervention), and 2,093 consecutive patients who underwent the same procedures between January 1, 1998, and October 31,1998 (postintervention). INTERVENTION: A program to prevent venous thromboembolism developed from American College of Chest Physicians guidelines, and an altered work process directed by a computerized reminder system. MEASUREMENTS: Rates of symptomatic, objectively confirmed deep vein thrombosis (DVT), pulmonary embolism (PE), and death attributable to venous thromboembolism occurring within 90 days of the date of surgery. RESULTS: The preintervention and postintervention cohorts did not differ with respect to age, severity of illness, number of risk factors for venous thromboembolism, or individual risk factors for venous thromboembolism. The overall prophylaxis rate increased from 89.9% before implementation of the computerized reminder system to 95.0% after implementation (p < 0.0001). The combined 90-day rate of symptomatic DVT, PE, and death attributable to PE remained the same (preintervention, 1.0%; postintervention, 1.2%; odds ratio, 1.21; 95% confidence interval, 0.67 to 2.20). Forty of 46 venous thromboembolic complications (87%) occurred despite the delivery of American College of Chest Physicians-recommended measures to prevent venous thromboembolism. CONCLUSIONS: Computerized reminder systems combined with altered care procedures increase the rate of prophylaxis against venous thromboembolism without decreasing the rate of symptomatic venous thromboembolism when the baseline rate of prophylaxis is high. A population of surgical patients exists who are resistant to American College of Chest Physicians-recommended prophylactic measures against venous thromboembolism. New strategies are needed to address prophylaxis-resistant venous thromboembolism.

Aged↗

PubMed2006

Design and evaluation of a computer reminder system to improve prescribing behaviour of GPs.

OBJECTIVE: To evaluate the implementation of a decision support system with reactive computer reminders to improve drug prescribing behaviour. METHODS: A clustered RCT with an incomplete block design was carried out in the south of the Netherlands: 25 GPs received reminders on antibiotics and asthma/COPD prescriptions, 28 GPs received reminders on cholesterol prescriptions. Prescribing guidelines were integrated into the GP information system, which was installed in the GPs practices of the intervention group. When the computer program was in use, a reminder popped up if the GP deviated from the guidelines during prescribing. PRIMARY OUTCOME: prescription according to the guidelines as a percentage of total prescriptions of a specific drug. Furthermore, an evaluation on the user-friendliness of the CRS in the GP's practice was carried out through questionnaires and interviews. RESULTS: Presently analyses are being carried out. Preliminary results indicate that the CRS study supported our expectations. In general, there seems to be a reduction in the numbers of prescriptions according to the advices of the computerised guidelines not to prescribe certain drugs. Final analysis will be performed shortly. In general, the Computer Reminder System was perceived as stable and user friendly. CONCLUSION: We created a stable and user friendly Computer Reminder System which was adjusted to the needs and demands of GPs. Preliminary results regarding the effectiveness of the system seem to indicate that the implementation of a Computer Reminder System with reactive reminders improves drug prescribing behaviour.

Drug Prescriptions↗

PubMed1985

Evaluation of a medication refill reminder system for a community pharmacy.

The problem of maintaining compliance in patients taking chronic medications is well established. One recommended approach to reducing this problem is to develop a system which identifies non-compliers in order that interventions can be devised to improve that behavior. A medication refill reminder system is an example of this approach. The refill behavior was observed for 102 cardiovascular patients who were patrons of one community pharmacy in order to assess the effects of a postcard/telephone reminder system. Patients who failed to refill their prescriptions on time were sent a postcard reminding them to have them refilled. A telephone call would follow if the patient failed to visit the pharmacy after the postcard. The study results showed that the average day s late for patients who failed to refill their prescription as expected decreased from 19.15 to 6.6 days after the reminder system was used (P less than 0.005). In addition, the percent of late refills of these patients was 13% less than controls. These findings provide strong evidence that a refill reminder system can be used successfully in a community pharmacy as part of a program to identify non-compliant patients and improve their compliance with chronic medication therapy.

Cardiovascular Diseases↗

PubMed1994

Improving a preventive services reminder system using feedback from focus groups.

OBJECTIVE: To improve the computer-generated preventive services patient reminder letter used by a department of family medicine at a medical university in South Carolina. DESIGN: A qualitative method chosen because of its demonstrated efficacy in generating in-depth attitude and opinion data was used for 12 focus groups (111 participants) in which participants were asked to evaluate the reminder letter and other preventive services reminder materials. Information from these groups was used to design a revised patient reminder system that was tested in six additional focus groups (50 participants). SETTING: University-based family medicine center. PARTICIPANTS: Adults 19 years of age or older of whom approximately one half were selected from a random sample of family medicine center patients and the remainder from volunteers recruited from the general community by newspaper advertisement. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Participants' perceptions and attitudes about the reminder letter and other materials as well as suggestions for improving the preventive services reminder system. RESULTS: The revised patient reminder materials resulted in a warmer, more personal letter sent to patients at the time of their birthdays in an envelope containing a prevention message. A leaflet describing the rationale for preventive services and answering common questions about prevention and a booklet describing the preventive services available at the family medicine center were also developed. CONCLUSION: This study illustrated the benefits of incorporating patients' perspectives in the design of preventive services reminders.

Adult↗

PubMed1984

A nurse-initiated reminder system for the periodic health examination. Implementation and evaluation.

Implementation of specific health maintenance recommendations into practice settings has been difficult. We introduced a nurse-initiated health maintenance reminder system into a university-based internal medicine practice setting. We then compared performance of selected items (Papanicolaou smear, stool examination for occult blood, breast examination, and influenza immunization) in the practice before and after institution of the system. The system required no additional personnel and was quickly learned by the nursing staff. There were significant increases in the performance of stool examination for occult blood (32% to 47%), breast examination (29% to 46%), and influenza immunization (18% to 40%) after the reminder system was introduced. A nurse-initiated health maintenance reminder system is a feasible and effective method for implementing periodic health examination procedures into a practice setting.

Aged↗