Improving pneumococcal vaccine rates : Nurse protocols versus clinical reminders

Similar general medical outpatient clinics with randomly assigned patients were used to evaluate the effectiveness of a program that was to increase house staff compliance with preventive medicine guidelines. Two clinics were designated experimental and two served as controls. In the experimental clinics, age-specific checklists of all recommended preventive procedures (drawn from the Canadian Task Force report on The Periodic Health Examination and American Cancer Society guidelines) were appended to each patient's chart. In addition, house officers were presented with a series of weekly seminars dealing with issues in screening, as well as the specific recommendations included in the checklist. House officers in all four clinics were tested for their knowledge and attitudes toward the preventive program before and after the intervention. Counts of immunizations and mammograms performed and the total populations eligible for these procedures were determined for all four clinics. As predicted, test scores as well as mammography and immunization rates increased significantly (from 2-40 per cent) in the intervention clinics as compared with controls. We conclude that this intervention was clearly effective in the short run. However, follow-up studies will be necessary to determine whether the desired long-term effect has been achieved.

Recent re-evaluation of preventive health care has resulted in more limited and directed guidelines; nonetheless, physician compliance has remained poor. This study assessed whether an inexpensive reminder system of preventive care checklists would improve physician implementation of periodic health measures. Residents in internal medicine were randomly placed into two groups: one received a copy of the appropriate checklist with each patient's medical record; the other did not. After one year, 200 randomly selected records were audited to determine the proportion of recommendations implemented for each patient. Residents who received checklists performed appropriate preventive health measures at a significantly higher rate than those who did not (0.56 +/- 0.26 versus 0.39 +/- 0.22, p less than 0.002). The actual use of the checklist to record the results was associated with an even higher rate of compliance compared with instances in which the checklists were provided but not used and instances in which checklists were not received (0.70 +/- 0.21 versus 0.44 +/- 0.24 and 0.39 +/- 0.22, respectively, p less than 0.002). These data suggest that a physician's use of simple checklists can provide an inexpensive and effective means of improving implementation of periodic health maintenance.