Changing Clinical Practice Through Patient Specific Reminders Available at the Time of the Clinical Encounter: Systematic Review and Meta-Analysis

Abstract

OBJECTIVE: To synthesise current evidence for the influence on clinical behaviour of patient-specific electronically generated reminders available at the time of the clinical encounter. DATA SOURCES: PubMed, Cochrane library of systematic reviews; Science Citation Index Expanded; Social Sciences Citation Index; ASSIA; EMBASE; CINAHL; DARE; HMIC were searched for relevant articles. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: We included controlled trials of reminder interventions if the intervention was: directed at clinician behaviour; available during the clinical encounter; computer generated (including computer generated paper-based reminders); and generated by patient-specific (rather than condition specific or drug specific) data. STUDY APPRAISAL AND SYNTHESIS METHODS:Systematic review and meta-analysis of controlled trials published since 1970. A random effects model was used to derive a pooled odds ratio for adherence to recommended care or achievement of target outcome. Subgroups were examined based on area of care and study design. Odds ratios were derived for each sub-group. We examined the designs, settings and other features of reminders looking for factors associated with a consistent effect. RESULTS: Altogether, 42 papers met the inclusion criteria. The studies were of variable quality and some were affected by unit of analysis errors due to a failure to account for clustering. An overall odds ratio of 1.79 [95% confidence interval 1.56, 2.05] in favour of reminders was derived. Heterogeneity was high and factors predicting effect size were difficult to identify. LIMITATIONS: Methodological diversity added to statistical heterogeneity as an obstacle to meta-analysis. The quality of included studies was variable and in some reports procedural details were lacking. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:The analysis suggests a moderate effect of electronically generated, individually tailored reminders on clinician behaviour during the clinical encounter. Future research should concentrate on identifying the features of reminder interventions most likely to result in the target behaviour.

Improving anticoagulation in atrial fibrillation: observational study in three primary care trusts

“…Comparing the 2 years before the intervention with the 2 years after, numbers of new people on the AF register almost doubled from 108 to 204. theories of behaviour change and practical exemplars. [22][23][24][25][26] They comprise altering professional beliefs using guidelines and education; 26,27 making changes in treatment easier for staff and patients with computer decision support and patient recall tools; 28 and motivating practices by publishing comparative performance. 29,30 Financial incentives may further improve performance 31 but were not used in the current study.…”

Reduction in self-monitoring of blood glucose in type 2 diabetes: an observational controlled study in east London

“…[19][20][21] No specific payment was used to incentivise performances, although practices in Tower Hamlets Clinical Commissioning Group (CCG), one of the intervention CCGs, could submit a completed audit of SMBG as part of a wider prescribing incentive scheme, for which they received a payment. In 2012, a similar scheme was introduced in Newham, the control CCG.…”

The General Practitioner Prompt Study to Reduce Cardiovascular and Renal Complications in Patients With Type 2 Diabetes and Renal Complications: Protocol and Baseline Characteristics for a Cluster Randomized Controlled Trial (Preprint)

“…More specifically, it has been shown to improve adherence to medication in studies targeting a reduction in CVD risk in people with T2DM 13,14 . The provision of patient 'reminders' and audit and feedback are facilitated through existing practice IT systems 15 . This highlights opportunities for intervention in patients at the time of clinical encounter and is effective in improving HCP behaviour to achieve patient risk factor targets 15 .…”

“…The provision of patient 'reminders' and audit and feedback are facilitated through existing practice IT systems 15 . This highlights opportunities for intervention in patients at the time of clinical encounter and is effective in improving HCP behaviour to achieve patient risk factor targets 15 .…”