Objective: To evaluate the causes of medication list inaccuracy, implement intervention to enhance overall accuracy of medication lists and measure the sustainability of the intervention. Methods: A prospective study of patients seen in an academic, ambulatory primary care internal medicine clinic. Before the intervention, baseline data were analysed, assessing completeness of medication documentation in the electronic medical record. The intervention consisted of standardising the entire visit process from scheduling of the appointment to signing of the final clinical note by the physician. Each healthcare team member was instructed in her role to enhance accuracy of the documented medication list. Immediately after the intervention, a second data collection was undertaken to assess the effectiveness of the intervention on the accuracy of individual medications and medication lists. Finally, a year later, a third data collection was undertaken to assess the sustainability of the intervention. Results: Completeness of individual medications improved from 9.7% to 70.7% (p,0.001). However, completeness of the entire medication lists improved only from 7.7% to 18.5%. The incomplete documentation of medication lists was mostly due to lack of route (85.8%) and frequency (22.3%) for individual medications within a medication list. Also, documentation of over-the-counter and ''as needed'' medications was often incomplete. The incorrectness in a medication list was mostly due to misreporting of medications by patients or failure of clinicians to update the medication list when changes were made. Conclusion: To improve the accuracy of medication lists, active participation of all members of the healthcare team and the patient is needed.

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OBJECTIVE -To determine whether women with diabetes undergo fewer screening mammograms than matched control subjects.RESEARCH DESIGN AND METHODS -A total of 424 women with diabetes aged 50 -75 years who received their primary care from general internists at a large Midwestern multispecialty group practice were retrospectively studied for frequency of mammography from August 1997 to January 2000. Two control subjects without diabetes (n ϭ 845) were matched to each case by age, sex, provider, and date of visit. The main outcome measure was the percentage of subjects undergoing mammography 1 year before and 30 days after an index date, defined as the most recent health care visit after August 1997 and before January 2000.RESULTS -Analysis by conditional logistic regression demonstrated that women with diabetes had significantly lower rates of mammograms than control subjects (78.1 vs. 84.9%, respectively; odds ratio 0.63, P ϭ 0.002). After adjusting for insurance status and race, women with diabetes continued to have significantly lower rates of mammography (odds ratio 0.70, P ϭ 0.027).CONCLUSIONS -Women with diabetes were significantly less likely to undergo screening mammography than control subjects. Considering the increasing incidence of diabetes and the equal incidence of malignancy in women with and without diabetes, it would be beneficial to improve breast cancer screening in this population.

Background: Screening mammography is recommended for early detection of breast cancer but screening rates remain suboptimal.Methods: A primary care portal for a large academic primary practice was developed for all preventive services. Another Web-based system (PRECARES [PREventive CAre REminder System]) was developed for appointment secretaries to manage proactive breast cancer screening. Female patients aged 40 to 75 years were randomly assigned to a control group (usual care) and an intervention group. For the intervention group, 2 monthly letters inviting patients to undergo mammography were sent starting 3 months before they were due for annual screening, followed by a telephone call to nonresponding patients. A subgroup of women employees was further randomized to receive a reminder by either US mail or e-mail.Results: Of the total eligible population of 6665 women identifiedashavingconsentedtoparticipateinresearch,3339 were randomly assigned to the control group and 3326 to the intervention group. The screening rate for annual mammography was 64.3% for the intervention group and 55.3% for the control group (PϽ.001). There were no significant differences between the 2 groups for any of the other adult preventive services. For the employee subgroup, the screening rate was 57.5% for the control group, 68.1% for the US mail group, and 72.2% for the e-mail group (intervention vs control, PϽ.001; e-mail vs US mail; P=.24). Conclusion:The breast cancer screening rate improved significantly with the practice redesign of having appointment secretariesproactivelymanagebreastcancerscreeningneeds.

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