Department of Primary Care Health Sciences, University of Oxford, 2nd floor, 23-38 Hythe Bridge Street, Oxford, OX1 2ET, UK.
J Gen Intern Med. 2012 Aug;27(8):974-84. doi: 10.1007/s11606-012-2025-5. Epub 2012 Mar 10.
To synthesise current evidence for the influence on clinical behaviour of patient-specific electronically generated reminders available at the time of the clinical encounter.
PubMed, Cochrane library of systematic reviews; Science Citation Index Expanded; Social Sciences Citation Index; ASSIA; EMBASE; CINAHL; DARE; HMIC were searched for relevant articles.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: We included controlled trials of reminder interventions if the intervention was: directed at clinician behaviour; available during the clinical encounter; computer generated (including computer generated paper-based reminders); and generated by patient-specific (rather than condition specific or drug specific) data.
Systematic review and meta-analysis of controlled trials published since 1970. A random effects model was used to derive a pooled odds ratio for adherence to recommended care or achievement of target outcome. Subgroups were examined based on area of care and study design. Odds ratios were derived for each sub-group. We examined the designs, settings and other features of reminders looking for factors associated with a consistent effect.
Altogether, 42 papers met the inclusion criteria. The studies were of variable quality and some were affected by unit of analysis errors due to a failure to account for clustering. An overall odds ratio of 1.79 [95% confidence interval 1.56, 2.05] in favour of reminders was derived. Heterogeneity was high and factors predicting effect size were difficult to identify.
Methodological diversity added to statistical heterogeneity as an obstacle to meta-analysis. The quality of included studies was variable and in some reports procedural details were lacking.
The analysis suggests a moderate effect of electronically generated, individually tailored reminders on clinician behaviour during the clinical encounter. Future research should concentrate on identifying the features of reminder interventions most likely to result in the target behaviour.
综合当前电子生成的临床会诊时可用的个性化提醒对临床行为的影响证据。
在 PubMed、Cochrane 系统评价图书馆、科学引文索引扩展版、社会科学引文索引、ASSIA、EMBASE、CINAHL、DARE、HMIC 中搜索相关文章。
研究入选标准、参与者和干预措施：如果干预措施为：针对临床医生行为；在临床会诊期间可用；计算机生成（包括计算机生成的纸质提醒）；并且由患者特定（而非特定于条件或特定于药物）数据生成，则纳入提醒干预的对照试验。
对 1970 年以来发表的对照试验进行系统评价和荟萃分析。使用随机效应模型得出对建议护理的依从性或目标结果的实现的汇总优势比。根据护理领域和研究设计对亚组进行检查。为每个亚组得出优势比。我们检查了提醒的设计、设置和其他特征，寻找与一致效果相关的因素。
共有 42 篇论文符合纳入标准。研究质量参差不齐，由于未能考虑聚类，一些研究受到分析单位错误的影响。得出了有利于提醒的总体优势比为 1.79 [95%置信区间 1.56, 2.05]。异质性很高，难以确定预测效应大小的因素。
方法学多样性增加了统计学异质性，成为荟萃分析的障碍。纳入研究的质量参差不齐，在一些报告中缺乏程序细节。
分析表明，电子生成的个性化提醒对临床会诊期间临床医生的行为有适度影响。未来的研究应集中于确定最有可能导致目标行为的提醒干预的特征。
