Turner B J, Day S C, Borenstein B
Department of Medicine, Thomas Jefferson University, Jefferson Medical College, Philadelphia, PA.
J Gen Intern Med. 1989 Sep-Oct;4(5):403-9. doi: 10.1007/BF02599691.
To improve the delivery of preventive care in a medical clinic, a controlled trial was conducted of two interventions that were expected to influence delivery of preventive services differently, depending on level of initiative required of the physician or patient to complete a service.
A prospective, controlled trial of five-months' duration.
A university hospital-based, general medical clinic.
Thirty-nine junior and senior medical residents who saw patients in stable clinic teams throughout the study.
A computerized reminder system for physicians and a patient questionnaire and educational hand-out on preventive care.
Delivery of five of six audited preventive services improved significantly after the interventions were introduced. The computerized reminder alone increased completion rates of services that relied primarily on physician initiative; the questionnaire alone increased completion rate of the service that depended more on patient compliance as well as on some physician-dependent services. Both interventions used together were slightly less effective in improving performance of physician-dependent services than the computerized reminder used alone.
These interventions can improve the delivery of preventive care but they differ in their impacts on physician and patient behaviors. Overall, the computer reminder was the more effective intervention.
为改善一家诊所的预防性医疗服务，开展了一项对照试验，试验中有两种干预措施，预计这两种措施会根据医生或患者完成一项服务所需的主动程度不同而对预防性服务的提供产生不同影响。
一项为期五个月的前瞻性对照试验。
一家大学附属医院的普通内科诊所。
39名初级和高级住院医师，在整个研究过程中他们在稳定的诊所团队中接待患者。
为医生配备计算机提醒系统，以及一份患者问卷和一份关于预防性医疗的教育手册。
引入干预措施后，六项经审核的预防性服务中的五项的提供情况有显著改善。仅计算机提醒就提高了主要依赖医生主动参与的服务的完成率；仅问卷就提高了更多依赖患者依从性以及一些依赖医生的服务的完成率。两种干预措施一起使用在改善依赖医生的服务的表现方面，比单独使用计算机提醒的效果稍差。
这些干预措施可以改善预防性医疗服务的提供，但它们对医生和患者行为的影响有所不同。总体而言，计算机提醒是更有效的干预措施。
