Computerized reminders to encourage cervical screening in family practice

• HIT Description: A computerized patient registry that recorded patient diagnoses, prescriptions, treatment, and billing information. It allowed identifying patients due for preventive procedures at any time and generating reminders. More info...
  
• Purpose of Study: Compare the effectiveness and cost-effectiveness of active and passive ways to increase rates of cervical screening.
  
• Years of study: 1985 for one year
  
• Study Design: Randomized controlled trial
  
• Outcomes: The proportion of patients in each intervention group that obtained a Papanicolaou smears reading during the study year; staff and material costs of reminding the patient
  

• Settings: Family Medicine Center at the Ottawa Civic Hospital, Canada, a teaching unit of the university medical school. The Center has six practices, each with a staff physician, a nurse, and between three and five family-medicine residents. Four practiced participated in the trial.
• Intervention: 1,587 women aged 18 through 35 years who were overdue for a Papanicolaou smears were assigned to either a normal-care control group or one of three intervention groups Ð 1) physician reminders (passive, happened to patients who visit the practice), 2) telephone reminders (active, reach out to patients), or 3) letter reminders (active, reach out to patients). The reminders were generated by the computer.
• Evaluation Method: Reviewing computer records for compliance rate and comparing the cost-effectiveness of the three intervention arms with control group as the comparator.
• HIT System: Described elsewhere (Rosser WW, Fluker G. Software for family practice: a decade of development. Can Fam Physician 1984; 30:2567).
• Costs: Cost of HIT systems was not reported. Instead, cost reported was the operational cost for each intervention arm. The cost for the letter reminders was $12.34 per additional screening gained (not stated as to year, presumably 1988 Canadian dollars). The cost increased if the physician's time to sign the letter was included, to $14.23 at an hourly salary of $60 for the physician. The nurse reminder took an average of 2.8 minutes per woman. Depending on the salary, the cost per screening gained ranged from $4.38 (salary $5 per hour for a nurse) to $11.26 ($10 per hour). The physician required an estimated 45 seconds to explain cervical screening to each woman. The cost per screening gained for the physician reminder was $11.75 for $60 per hour salary rate or $5.88 for $30 per hour salary rate.
• Clinical Outcomes: á Changes in healthcare utilization: In the randomized control group, 13.7% of all those due for a cervical screening obtained one during the study year. The physician's reminder added 2.4% (to 16.1%), the telephone reminder 6.3% (to 20.0%), and the letter reminder 12.2% (to 25.9%). The active reminder groups (letter or telephone reminders) differed significantly from the randomized control group, but the passive reminder group (physician reminder) did not.
• Changes in efficiency and productivity: The author claimed that computerized record systems offer a practical and efficient way to identify patients due for preventive procedures and to generate reminders to promote the procedures in a family practice. However, no comparison was made as to compare manual versus computer reminder generation approach.