Randomized Controlled Trial of a Computer Strategy to Increase General Practitioner Preventive Care

Bonevski, Billie; Sanson‐Fisher, Rob; Campbell, Elizabeth; Carruthers, Anne; Reid, Alexander; Ireland, Malcolm

doi:10.1006/pmed.1999.0567

Cited by 65 publications

(80 citation statements)

References 42 publications

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“…Fifteen were quasi randomised (Baele 1998;Chumworathayi 2007;Hicks 1997;Hou 2002;Hou 2005;Lantz 1995;Lantz 1996;Levine 2003;Marcus 1992;Margolis 1998;Maxwell 2003;Park 2005;Paskett 1990;Ward 1999;Yancey 1995), three studies included participants who may have been screened before receiving the intervention (Dignan 1996;Dignan 1998;Gotay 2000), ten studies used an intervention aimed at either the physician or both the physician and patient (Boissel 1995;Bonevski 1999;Campbell 1997;Cecchini 1989;Hillman 1998;Litzelman 1993;Manfredi 1998;Nguyen 2000;Roetzheim 2004;Roetzheim 2005), seven studies used an intervention or an outcome that was not strictly concerned with increasing uptake (Brewster 2002;Del Mar 1995;Holloway 2003;Katz 2007;Paul 2003;Philips 2006;Sankaranarayanan 2003;), nine studies concerned intervention aimed at improving follow-up of an abnormal smear results rather than initial Pap screening uptake (Engelstad 2005;Lauver 1990;Marcus 1998;Miller 1999;Paske...…”

Section: Assessment Of Risk Of Bias In Included Studies-the Risk Of Bmentioning

confidence: 99%

Interventions targeted at women to encourage the uptake of cervical screening

Forbes

Jepson

Martin-Hirsch

2002

Cochrane Database of Systematic Reviews

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Section: Assessment Of Risk Of Bias In Included Studies-the Risk Of Bmentioning

confidence: 99%

Interventions targeted at women to encourage the uptake of cervical screening

Forbes

Jepson

Martin-Hirsch

2002

Cochrane Database of Systematic Reviews

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“…A search of the medical literature for the terms "continuing medical education" and "hypertension" or "blood pressure" yielded only five relevant clinical studies. [21][22][23][24][25] However, these studies do provide some insights into the types of interventions that are likely to affect the prescribing practices of primary care physicians. The investigators in a Canadian study 22 reported that physicians who participated in educational programs were significantly more likely to be following recommendations for hypertension management 6 and 12 months after an intervention than were those who were not offered the educational intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Investigators conducting a randomized study in Sweden 23 identified an increase in the number of physicians following designated prescribing practices for antihypertensive medications 1 year following an intervention based on feedback regarding prescribing rates, along with problem-oriented outreach education. In an Australian study, 24 physicians were randomized either to a group provided computerized feedback regarding preventive health behaviors, including blood pressure screening, or to a control group. At 3 months, a statistically significant difference between the two groups was identified: physicians in the intervention group were 3.4 times more likely to conduct blood pressure screenings than physicians who did not receive the intervention (p<0.001).…”

Section: Discussionmentioning

confidence: 99%

The Hypertension Management Program: Identifying Opportunities for Improvement

Maue

Jackson

Weiss

et al. 2003

J of Clinical Hypertension

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are aware of the condition and 53% are being treated for hypertension, yet only about 30% have blood pressure controlled to a level of <140/90 mm Hg. 2 Because it is possible to control hypertension with lifestyle modifications and antihypertensive medication regimens, these data strongly suggest that suboptimal medical management plays a major role in uncontrolled hypertension. A large majority of the nearly 50 million Americans with hypertension are diagnosed and treated in primary care settings. 3 Systems-related problems, such as a lack of provider follow-up or limited time for patient education, may be at the core of poor management of hypertension. 4 Methods for improving blood pressure control must be identified and applied systematically to be successful; however, data regarding specific factors associated with blood pressure control in real-world clinical settings are lacking. Most significantly, clinical outcomes are seldom measured to determine the true impact of health care management strategies. 5 Thus, both successful and unsuccessful strategies to improve blood pressure control are largely unidentified. This paper reviews elements associated with successful clinical outcomes following physician-oriented educational interventions, and describes the methods and introduces baseline and postintervention data from the Hypertension Management Program (HMP), an ongoing nationwide hypertension quality improvement program. HYPERTENSION MANAGEMENT PROGRAMThe primary goal of this nationwide project is to improve hypertension management and blood pressure control in patients with hypertension enrolled in population-based health care settings. The overall objectives of the study are to determine current hypertension management strategies and level of blood pressure control; to identify and recommend specific medical management strategies to improve

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“…18 We found 9 studies that involved feedback on physician performance in smoking cessation. [18][19][20][21][22][23][24][25][26] All studies used chart audit to provide feedback, and none reported direct observation of practice. One based feedback on encounter and pharmacy claims.…”

Section: Tobacco C Es S At Ion Qui T L Inementioning

confidence: 99%

Practice-Based Referrals to a Tobacco Cessation Quit Line: Assessing the Impact of Comparative Feedback vs General Reminders

Wadland¹,

Holtrop²,

Weismantel³

et al. 2007

The Annals of Family Medicine

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PURPOSE We undertook a study to assess the impact of comparative feedback vs general reminders on practice-based referrals to a tobacco cessation quit line and estimated costs for projected quit responses. METHODSWe conducted a group-randomized clinical trial comparing the impact of 6 quarterly (18 months) feedback reports (intervention) with that of general reminders (control) on practice-based clinician referrals to a quit-line service. Feedback reports were based on an Achievable Benchmark of Care approach using baseline practice, clinician, and patient survey responses, and referrals per quarter. Comparable quit responses and costs were estimated.RESULTS Three hundred eight clinicians participated (171 family medicine, 88 internal medicine, 49 obstetrics-gynecology) from 87 primary care practices in Michigan. After 18 months, there were more referrals from the intervention than from the control practices (484 vs 220; P <.001). Practice facsimile (fax) referrals (84%, n = 595) exceeded telephone referrals (16%, n = 109), but telephone referrals resulted in greater likelihood of enrollment (77% telephone vs 44% fax, P <.001). The estimated number of smokers who quit based on the level of services utilized by referred smokers was 66 in the feedback and 36 in the gentle reminder practices.CONCLUSION Providing comparative feedback on clinician referrals to a quit-line service had a modest impact with limited increased costs. INTRODUCTIONS moking cessation interventions have proved to be effective in primary care settings according to the systematic reviews of controlled clinical trials that resulted in Clinical Practice Guidelines on Smoking Cessation by the Public Health Service.1,2 Clinicians report various reasons for not following the guidelines, such as focusing on acute or chronic care rather than preventive care, having little training in giving brief advice to quit smoking, and not being subject to accountability or feedback. 3,4 Survey fi ndings show that physicians understand the importance of smoking cessation and espouse its value, but they often do not implement the key elements of offi ce-based methods. 3,4 Physicians rarely schedule smokers for follow-up visits or arrange referrals for support services.1,3-5 Several community-based and health-system-based studies have shown fairly high rates of long-term smoking cessation (20% to 36%) by combining physician identifi cation, advice, and referral for follow-up care with telephone support counseling. [6][7][8][9][10][11] Telephone counseling services for smoking cessation (quit lines) have become widely available through health plans and state or national services, 12 but they are often underutilized. Methods to enhance clinician referrals to quit-line services are needed. 136 TOBACCO C ES S AT ION QUI T L INEFeedback on clinical performance has been studied in numerous randomized clinical trials and reported in systematic reviews to have modest effects.13 Comparing personal performance with peer performance should be a powerful motivator ...

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Randomized Controlled Trial of a Computer Strategy to Increase General Practitioner Preventive Care

Cited by 65 publications

References 42 publications

Interventions targeted at women to encourage the uptake of cervical screening

Interventions targeted at women to encourage the uptake of cervical screening

The Hypertension Management Program: Identifying Opportunities for Improvement

Practice-Based Referrals to a Tobacco Cessation Quit Line: Assessing the Impact of Comparative Feedback vs General Reminders

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