Opportunistic reminders and other influences on the performance of preventive activities in consultations in general practice

Introduction - Eighty five per cent of Australians visit a GP each year, but do not receive all of the preventive care which is indicated for them. There have been no controlled trials of the effects of on-screen preventive care reminders in Australian general practice, and there is little published research examining characteristics of patients, doctors and consultations associated with the performance of preventive services in general practice. This study aimed to measure the effects of opportunistic reminders and to explore previously unexamined patient, GP and consultation factors associated with performance of preventive activities. The hypotheses were : a ) that general practitioners who were using a computer medical record system would take at least fifteen per cent more of opportunities to perform preventive care activities if they were reminded ; b ) that this would occur without any significant increase in the number of consultations or in patient billings ; and c ) that every characteristic of patients, GPs, consultations and preventive opportunities would be significantly associated with the performance of the preventive activities. Method - All patients who attended a ten GP fully computerised practice during one year were enrolled and randomised either to an intervention group, for whom the GPs received opportunistic on-screen reminders about eleven preventive activities, or to a 'usual care' control group. Performance by the GPs of the preventive activities was recorded automatically and correlated with routinely-collected demographic and clinical information about the patients and billing data. Results - For the intervention group compared to the control group, the GPs took thirty two per cent more of the preventive opportunities without any increase in numbers of services or in patient billings. Every characteristic of patients, GPs, consultations and preventive opportunities was independently associated with the performance of at least two of the preventive activities. Discussion - This trial has shown that a low cost minimally-intrusive intervention in the form of automated opportunistic reminder messages can significantly improve GPs' performance of preventive care activities. The findings of this trial may help to improve the design and effectiveness of opportunistic reminders in clinical software, and provide direction about possible changes to the health system which may foster increased provision of preventive care.Thesis (Ph.D.)--University of Adelaide, School of Population Health and Clinical Practice, Discipline of General Practice, 2006