Clinical effect of computer generated physician reminders in health screening in primary health care--a controlled clinical trial of preventive services among the elderly.

Abstract

To apply and evaluate the effects of a program for computer generated physician reminders, integrated with an electronic patient record (EPR) system, for opportunistic health screening in elderly patients. A pilot study designed as a 20-month clinical trial with a control group and a 20-month non-intervention follow-up using a computer reminder program that selects patients for screening in five intervention areas (diabetes, hypertension, cobalamin deficiency, hypothyroidism and anaemia). Four primary health care (PHC) centres in suburban Stockholm. The intervention was designed for patients 70 years or older from one health care centre who visited a general practitioner (GP) during the first 20-month period. Patients from the three remaining centres served as controls. The number of patients who underwent the tests, who had pathological test results, new diagnoses and new pharmacological treatments in both patient groups. In total, 602 patients underwent screening and 1989 were controls. There was a statistically significant, moderate or marked increase (13-75%) in the number of patients who were tested in all five intervention areas. An increase in pathological test results (1-8%) was found in two areas: hypertension and cobalamin deficiency. There was an increase in the number of patients with the diagnosis of cobalamin deficiency during the study. At follow-up a decrease in new diagnoses for anaemia was found. The system seems to be associated with a moderate to large increase in laboratory and manual screening tests for both established and new screening areas. The effect on clinical outcomes was found mainly in a not-yet-established screening area (cobalamin deficiency), indicating that the system may be clinically useful when introducing new screening services.