Reminder Systems
Decision Support Systems, Clinical
Medical Records Systems, Computerized
Computer Systems
Diagnosis, Computer-Assisted
Practice Guidelines as Topic
Guideline Adherence
Primary Health Care
Mass Screening
Physician's Practice Patterns
Postal Service
Measuring the effects of reminders for outpatient influenza immunizations at the point of clinical opportunity. (1/589)
OBJECTIVE: To evaluate the influence of computer-based reminders about influenza vaccination on the behavior of individual clinicians at each clinical opportunity. DESIGN: The authors conducted a prospective study of clinicians' influenza vaccination behavior over four years. Approximately one half of the clinicians in an internal medicine clinic used a computer-based patient record system (CPR users) that generated computer-based reminders. The other clinicians used traditional paper records (PR users). MEASUREMENTS: Each nonacute visit by a patient eligible for an influenza vaccination was considered an opportunity for intervention. Patients who had contraindications for vaccination were excluded. Compliance with the guideline was defined as documentation that a clinician ordered the vaccine, counseled the patient about the vaccine, offered the vaccine to a patient who declined it, or verified that the patient had received the vaccine elsewhere. The authors calculated the proportion of opportunities on which each clinician documented action in the CPR and PR user groups. RESULTS: The CPR and PR user groups had different baseline compliance rates (40.1 and 27.9 per cent, respectively; P<0.05). Both rates remained stable during a two-year baseline period (P = 0.34 and P = 0.47, respectively). The compliance rates in the CPR user group increased 78 per cent from baseline (P<0.001), whereas the rates for the PR user group did not change significantly (P = 0.18). CONCLUSIONS: Clinicians who used a CPR with reminders had higher rates of documentation of compliance with influenza-vaccination guidelines than did those who used a paper record. Measurements of individual clinician behavior at the point of each clinical opportunity can provide precise evaluation of interventions that are designed to improve compliance with guidelines. (+info)Randomised controlled trial of reminders to enhance the impact of audit in general practice on management of patients who use benzodiazepines. (2/589)
OBJECTIVE: To determine whether reminder cards in medical records enhance the effectiveness of audit with feedback in improving the care of patients taking long term benzodiazepine drugs. DESIGN: Randomised trial, practices receiving feedback only in one group and practices receiving feedback plus reminder cards in the other group. SETTING: 18 general practices in Leicestershire. SUBJECTS: Random samples of patients who had been taking a benzodiazepine anxiolytic or hypnotic drug for four weeks or longer. MAIN OUTCOME MEASURES: Entries in medical records indicating compliance with five criteria of care: assessment of suitability for withdrawal; being told about dependency; withdrawal being recommended; withdrawal or continuing medication; and a consultation with the general practitioner in the past year. Data were collected before and after feedback or feedback plus reminders. RESULTS: Of a total population of 125,846 registered with the 18 practices, 2409 (1.9%) had been taking a benzodiazepine for four weeks or longer. Of the 742 in the first samples, 543 (73.2%) were women, the mean (SD) age was 68.7 (14.9) years, and they had been taking a benzodiazepine for 10.1 (6.7) years. The number of patients whose care complied with the criteria rose after the interventions to implement change. The increase was greater in practices receiving feedback plus reminders for only two of the five criteria "told about dependency" increasing from 52 (11.1%) to 118 (25.8%) in the feedback only group, and from 27 (10.5%) to 184 (43.0%) in the feedback plus reminders group; odds ratio (OR) 1.46 (95% confidence interval (95% CI) 1.32 to 5.21); and "consulted in the past year" increasing from 434 (93.1%) to 411 (95.8%) in the feedback only group and 255 (96.6%) to 400 (99.8%) in the feedback plus reminders group, OR (95% CI) 13.5 (2.01 to 330.3). CONCLUSIONS: Reminder cards had only a limited effect and cannot be recommended for routine use. There were improvements in the care of patients of both groups of practices and further studies are indicated to determine the impact of both systematically developed criteria and reminders embedded into restructured medical records. (+info)Population health management with computerized patient records. (3/589)
CIGNA Healthcare of Arizona is using a computerized patient record system (EpicCare) for all medical care delivery at two primary care clinics. Use of this technology to improve quality of care for healthy populations and targeted groups of at-risk persons has led to population health management. This paper discusses strategies used in these endeavors. (+info)Management of diabetes mellitus in the Lovelace Health Systems' EPISODES OF CARE program. (4/589)
OBJECTIVE: To design and implement the Lovelace Diabetes EPISODES OF CARE program in a managed care setting. This program is intended to address the complex needs of patients with type 2 diabetes mellitus by using specific physician-provider and patient interventions. DESIGN: Observational study. SETTING: Lovelace Health Systems, the second-largest and most fully integrated health care delivery system in New Mexico. The main facility is located in Albuquerque. PARTICIPANTS: Lovelace Health Plan members with type 2 diabetes. INTERVENTIONS: Physician-provider interventions included practice guidelines medical profile screens, and provider support reports. Patients interventions included diabetes education; improved access to care, with focused diabetes clinic visits and "Diabetes Days"; and reminder systems. MAIN OUTCOME MEASURES: Glycohemoglobin values, dilated eye examination rates, and access to education. RESULTS: Significant lowering of glycohemoglobin values, dilated eye examination rates exceeding benchmark measures, and increases in educational access rates have occurred since the Lovelace Diabetes EPISODES OF CARE program was implemented. CONCLUSIONS: An integrated health care delivery system with a comprehensive, diabetes disease management program can substantially improve outcomes. (+info)Use of an automated pharmacy system and patient registries to recruit HMO enrollees for an influenza campaign. (5/589)
OBJECTIVE: To develop methods to identify, recruit, and vaccinate HMO enrollees at increased risk for influenza-related complications as part of a comprehensive influenza campaign. SETTING: Group Health Cooperative (GHC) is a large, membership-governed, managed care organization that serves 395,000 members in the Puget Sound area. APPROACH: An automated pharmacy system and patient data registries were used to identify enrollees with chronic illness. Enrollees with chronic illness and all enrollees 65 years of age and older were considered "high-risk" enrollees to be recruited for vaccination. Postcard reminders coupled with a publicity and education campaign were used to recruit high-risk enrollees to special influenza clinics. RESULTS: Our approach identified 2.5% of children (persons < 18 years of age) and 10.5% of adults (persons 18 to 65 years of age) as chronically ill and thus at high risk for influenza-related complications. Most high-risk children were identified through prescriptions for steroids, autonomic inhalers, or both or because they were enrolled in the asthma registry. Most high-risk adults were identified because of prescriptions for steroids, insulin, or oral hypoglycemic agents; because they had received pneumococcal vaccine; or because they were enrolled in the diabetes registry. Influenza coverage rates for all seniors (persons > or = 65 years of age) increased from 34% in 1984 to more than 72% in the 1996-1997 campaign year. Coverage rates were much lower for high-risk children (36%) and adults (46%). CONCLUSIONS: Influenza coverage rates can still be substantially improved for adults younger than 65 years of age and children at high risk for influenza-related complications. (+info)Improving pneumococcal vaccine rates. Nurse protocols versus clinical reminders. (6/589)
OBJECTIVE: To compare the effectiveness of three interventions designed to improve the pneumococcal vaccination rate. DESIGN: A prospective controlled trial. SETTING: Department of Veterans Affairs ambulatory care clinic. PATIENTS/PARTICIPANTS: There were 3, 502 outpatients with scheduled visits divided into three clinic teams (A, B, or C). INTERVENTIONS: During a 12-week period, each clinic team received one intervention: (A) nurse standing orders with comparative feedback as well as patient and clinician reminders; (B) nurse standing orders with compliance reminders as well as patient and clinician reminders; and (C) patient and clinician reminders alone. Team A nurses (comparative feedback group) received information on their vaccine rates relative to those of team B nurses. Team B nurses (compliance reminders group) received reminders to vaccinate but no information on vaccine rates. MEASUREMENTS AND MAIN RESULTS: Team A nurses assessed more patients than team B nurses (39% vs 34%, p =.009). However, vaccination rates per total patient population were similar (22% vs 25%, p =.09). The vaccination rates for both team A and team B were significantly higher than the 5% vaccination rate for team C (p <.001). CONCLUSIONS: Nurse-initiated vaccine protocols raised vaccination rates substantially more than a physician and patient reminder system. The nurse-initiated protocol with comparative feedback modestly improved the assessment rate compared with the protocol with compliance reminders, but overall vaccination rates were similar. (+info)Public health in managed care: a randomized controlled trial of the effectiveness of postcard reminders. (7/589)
OBJECTIVES: This study evaluated the effectiveness of an annual public health intervention in a managed care setting. METHODS: Managed care organization members 65 years and older who received influenza immunization in 1996 were randomized to an intervention group (mailed a postcard reminder to receive an influenza vaccination in 1997) or a control group (no postcard). Vaccination rates for both groups were assessed monthly. RESULTS: Members receiving the intervention were no more likely to be immunized (78.6%) than members of the control group (77.2%, P = .222). Members were vaccinated at the same pace regardless of vaccination history and postcard intervention status. CONCLUSIONS: Postcard reminders were not an effective intervention among seniors who had been vaccinated the previous year. (+info)Improving population-based cervical cancer screening in general practice: effects of a national strategy. (8/589)
OBJECTIVE: To assess the effects of a Dutch national prevention programme, aimed at general practitioners (GPs), on the adherence to organizational guidelines for effective cervical cancer screening in general practice. To identify the characteristics of general practices determining success. DESIGN: A prospective questionnaire study with pre- and post-measurement (before and 15 months after the introduction of the national programme). SETTING AND STUDY PARTICIPANTS: A random sample of one-third of all 4758 Dutch general practices. One GP was asked to participate per practice. INTERVENTION: A national GP prevention programme to improve population-based prevention of cervical cancer combining various methods for quality improvement in general practice, performed on a national, district and practice level. Outreach visitors were a key strategy in bringing about behavioural changes. MAIN OUTCOME MEASURES: The proportion of practices adhering to 10 recommendations (in four guidelines) to organize effective cervical cancer screening. RESULTS: After 15 months, all Dutch practices showed significant improvement in adherence to nine out of 10 recommendations. Two recommendations, in particular 'identifying women who should be medically excluded from screening' and 'sending a reminder to non-compliers' showed the largest absolute increases of 26% and 33%, respectively. Besides more intensive support of outreach visitors, practice characteristics such as 'computerization' and 'delegation of many clinical tasks to the practice assistant' were important in improving the adherence to guidelines. CONCLUSION: The national programme, with a combination of various methods for quality improvement, appeared to be effective in improving the organization of cervical screening in general practice. Computerization and, to a lesser extent, delegation of many clinical tasks to the practice assistant and more intensive support to practices, positively influenced the effectiveness of the national programme. (+info)A reminder system in a medical context is a tool or service that helps individuals or healthcare providers remember and adhere to certain health-related tasks or appointments. These systems can be manual, such as written reminders or calendar alerts, or automated, such as electronic messaging services, mobile apps, or wearable devices.
Reminder systems are often used to help patients remember to take their medications at the right time and dose, keep track of medical appointments, perform self-care activities, or monitor their health status. They can also be used by healthcare providers to remind patients about upcoming appointments, follow-up care, or test results.
Effective reminder systems have been shown to improve medication adherence, reduce missed appointments, and enhance overall patient outcomes.
Decision Support Systems (DSS), Clinical are interactive computer-based information systems that help health care professionals and patients make informed clinical decisions. These systems use patient-specific data and clinical knowledge to generate patient-centered recommendations. They are designed to augment the decision-making abilities of clinicians, providing evidence-based suggestions while allowing for the integration of professional expertise, patient preferences, and values. Clinical DSS can support various aspects of healthcare delivery, including diagnosis, treatment planning, resource allocation, and quality improvement. They may incorporate a range of technologies, such as artificial intelligence, machine learning, and data analytics, to facilitate the processing and interpretation of complex clinical information.
A Computerized Medical Record System (CMRS) is a digital version of a patient's paper chart. It contains all of the patient's medical history from multiple providers and can be shared securely between healthcare professionals. A CMRS includes a range of data such as demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports. The system facilitates the storage, retrieval, and exchange of this information in an efficient manner, and can also provide decision support, alerts, reminders, and tools for performing data analysis and creating reports. It is designed to improve the quality, safety, and efficiency of healthcare delivery by providing accurate, up-to-date, and comprehensive information about patients at the point of care.
Preventive health services refer to measures taken to prevent diseases or injuries rather than curing them or treating their symptoms. These services include screenings, vaccinations, and counseling aimed at preventing or identifying illnesses in their earliest stages. Examples of preventive health services include:
1. Screenings for various types of cancer (e.g., breast, cervical, colorectal)
2. Vaccinations against infectious diseases (e.g., influenza, pneumococcal pneumonia, human papillomavirus)
3. Counseling on lifestyle modifications to reduce the risk of chronic diseases (e.g., smoking cessation, diet and exercise counseling, alcohol misuse screening and intervention)
4. Screenings for cardiovascular disease risk factors (e.g., cholesterol levels, blood pressure, body mass index)
5. Screenings for mental health conditions (e.g., depression)
6. Preventive medications (e.g., aspirin for primary prevention of cardiovascular disease in certain individuals)
Preventive health services are an essential component of overall healthcare and play a critical role in improving health outcomes, reducing healthcare costs, and enhancing quality of life.
A computer system is a collection of hardware and software components that work together to perform specific tasks. This includes the physical components such as the central processing unit (CPU), memory, storage devices, and input/output devices, as well as the operating system and application software that run on the hardware. Computer systems can range from small, embedded systems found in appliances and devices, to large, complex networks of interconnected computers used for enterprise-level operations.
In a medical context, computer systems are often used for tasks such as storing and retrieving electronic health records (EHRs), managing patient scheduling and billing, performing diagnostic imaging and analysis, and delivering telemedicine services. These systems must adhere to strict regulatory standards, such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States, to ensure the privacy and security of sensitive medical information.
Computer-assisted diagnosis (CAD) is the use of computer systems to aid in the diagnostic process. It involves the use of advanced algorithms and data analysis techniques to analyze medical images, laboratory results, and other patient data to help healthcare professionals make more accurate and timely diagnoses. CAD systems can help identify patterns and anomalies that may be difficult for humans to detect, and they can provide second opinions and flag potential errors or uncertainties in the diagnostic process.
CAD systems are often used in conjunction with traditional diagnostic methods, such as physical examinations and patient interviews, to provide a more comprehensive assessment of a patient's health. They are commonly used in radiology, pathology, cardiology, and other medical specialties where imaging or laboratory tests play a key role in the diagnostic process.
While CAD systems can be very helpful in the diagnostic process, they are not infallible and should always be used as a tool to support, rather than replace, the expertise of trained healthcare professionals. It's important for medical professionals to use their clinical judgment and experience when interpreting CAD results and making final diagnoses.
Practice guidelines, also known as clinical practice guidelines, are systematically developed statements that aim to assist healthcare professionals and patients in making informed decisions about appropriate health care for specific clinical circumstances. They are based on a thorough evaluation of the available scientific evidence, consensus of expert opinion, and consideration of patient preferences. Practice guidelines can cover a wide range of topics, including diagnosis, management, prevention, and treatment options for various medical conditions. They are intended to improve the quality and consistency of care, reduce unnecessary variations in practice, and promote evidence-based medicine. However, they should not replace clinical judgment or individualized patient care.
Guideline adherence, in the context of medicine, refers to the extent to which healthcare professionals follow established clinical practice guidelines or recommendations in their daily practice. These guidelines are systematically developed statements designed to assist practitioners and patient decisions about appropriate health care for specific clinical circumstances. Adherence to evidence-based guidelines can help improve the quality of care, reduce unnecessary variations in practice, and promote optimal patient outcomes. Factors that may influence guideline adherence include clinician awareness, familiarity, agreement, self-efficacy, outcome expectancy, and the complexity of the recommendation.
Primary health care is defined by the World Health Organization (WHO) as:
"Essential health care that is based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process."
Primary health care includes a range of services such as preventive care, health promotion, curative care, rehabilitation, and palliative care. It is typically provided by a team of health professionals including doctors, nurses, midwives, pharmacists, and other community health workers. The goal of primary health care is to provide comprehensive, continuous, and coordinated care to individuals and families in a way that is accessible, affordable, and culturally sensitive.
Medical mass screening, also known as population screening, is a public health service that aims to identify and detect asymptomatic individuals in a given population who have or are at risk of a specific disease. The goal is to provide early treatment, reduce morbidity and mortality, and prevent the spread of diseases within the community.
A mass screening program typically involves offering a simple, quick, and non-invasive test to a large number of people in a defined population, regardless of their risk factors or symptoms. Those who test positive are then referred for further diagnostic tests and appropriate medical interventions. Examples of mass screening programs include mammography for breast cancer detection, PSA (prostate-specific antigen) testing for prostate cancer, and fecal occult blood testing for colorectal cancer.
It is important to note that mass screening programs should be evidence-based, cost-effective, and ethically sound, with clear benefits outweighing potential harms. They should also consider factors such as the prevalence of the disease in the population, the accuracy and reliability of the screening test, and the availability and effectiveness of treatment options.
Physician's practice patterns refer to the individual habits and preferences of healthcare providers when it comes to making clinical decisions and managing patient care. These patterns can encompass various aspects, such as:
1. Diagnostic testing: The types and frequency of diagnostic tests ordered for patients with similar conditions.
2. Treatment modalities: The choice of treatment options, including medications, procedures, or referrals to specialists.
3. Patient communication: The way physicians communicate with their patients, including the amount and type of information shared, as well as the level of patient involvement in decision-making.
4. Follow-up care: The frequency and duration of follow-up appointments, as well as the monitoring of treatment effectiveness and potential side effects.
5. Resource utilization: The use of healthcare resources, such as hospitalizations, imaging studies, or specialist consultations, and the associated costs.
Physician practice patterns can be influenced by various factors, including medical training, clinical experience, personal beliefs, guidelines, and local availability of resources. Understanding these patterns is essential for evaluating the quality of care, identifying potential variations in care, and implementing strategies to improve patient outcomes and reduce healthcare costs.
I'm sorry for any confusion, but "Postal Service" is not a term used in medical definitions. It generally refers to the system for delivering mail and packages, such as the United States Postal Service (USPS). If you have any questions about medical terminology or concepts, I'd be happy to help answer those!
I'm sorry for any confusion, but "Text Messaging" is not a term that has a specific medical definition. Text messaging generally refers to the act of sending short messages, usually comprised of text and/or media, through electronic communication systems, such as mobile phones or online platforms. If you're looking for a term with a medical connotation, perhaps you meant "Telemedicine" or "e-Prescribing," which are medical practices that involve the use of technology for communication and patient care.