The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #63145

Jesse Singer, DO, School of Public Health, Nova Southeastern University, 3200 S. University Drive, Fort Lauderdale, FL 33328, 305-762-7778, jesone@adelphia.net, Jennie Lou, MD, MSc, Master of Public Health Program, Nova Southeastern University, 3200 S. University Dr. HPD 1578, Ft. Lauderdale, FL 33328, Dr.Jean Malecki, Palm Beach County Department of Health, P.O. Box 29, 826 Evernia Street, West Palm Beach, FL 33401, and Darin Rubin, DO, Primary Care, West Palm Beach VA Hospital, 7305 N. Military Trail, West Palm Beach, FL 33410.

PURPOSE: Literature has shown the compliance of physicians with preventive medicine guidelines has been less than ideal. The objective of this study was to assess the benefit of a computerized reminder system on (1) physicians' compliance of ordering the preventive medicine interventions according to the preventive medicine guidelines; and (2) the actual completion rate of interventions, following physicians' orders.

METHODS: Retrospective medical records review of patient visits was used. Total of 498 medical charts from January to September 2002 at the West Palm Beach VA Hospital were reviewed to compare the physicians' compliance of ordering annual urine microalbumin test, one preventive guideline recommendation for patients with type II diabetes. The actual completion rates of annual urine microalbumin test, before and after the computerized reminder system was implemented, were also compared. The significance of the differences were analyzed through the Z test for a 2x2 table.

RESULTS: The physicians' compliance rate of ordering the annual urine microalbumin test, for patients with type II diabetes, increased significantly from 29% to 66% (X2=60.16, df=1, p<0.001). After the implementation of the computerized reminder system at VA hospital in West Palm Beach, Florida, The actual completion rate of the annual urine microalbumin test also increased significantly from 29% to 55% (X2=30.18, df=1, p<0.001),

CONCLUSIONS: The data supported the hypothesis that the implementation of a computerized reminder system has significant benefits to (1) increase the physicians' compliance of ordering preventive medicine interventions according to the guidelines; and (2) increase the actual completion of the tests ordered. However, there is still a large discrepancy between physicians' orders and actual completion of these interventions.

Learning Objectives:

"At the conclusion of the session, the participant (learner) in this session will be able to:
• Identify the significant impact clinical reminders can have on physician compliance with preventive medicine guidelines.
• Recognize that although physicians may increase their ordering of preventive medicine interventions, the interventions do not get completed at the same rate.

Keywords: Preventive Medicine, Information System Integration

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.