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A Patient-Initiated System for Preventive Health Care
A Randomized Trial in Community-Based Primary Care Practices
Robert B. Williams, MD;
Myde Boles, PhD;
Robert E. Johnson, PhD
Arch Fam Med. 1998;7:338-345.
Objective To test the effectiveness of a patient-initiated, touch-sensitive computer system (TSCS) for improving screening rates for cancers of the breast, cervix, colon and rectum, and oral cavity.
Design One-year, randomized, controlled trial with primary care practice as the unit of analysis.
Setting Sixty primary care practices, randomly recruited from 329 nonteaching practices in a southeastern state.
Subjects Random sample of the medical records of 50 male and female adult patients before intervention and 50 adult patients after intervention in each practice and a random sample of 507 TSCS users.
Interventions Touch-sensitive computer system and a registered nurse who served as liaison to the study practices. The TSCS provided patient-specific preventive service recommendations and facilitated work flow to increase the completion of these interventions.
Main Outcome Measure Average change, adjusted for health maintenance examination (HME) and use of the TSCS, in the proportion of eligible patients undergoing screening mammography, clinical breast examination, digital rectal examination, fecal occult blood test, flexible sigmoidoscopy, Papanicolaou smear, and oral cavity examination.
Results We observed a significant increase in the completion of screening mammography (6.6%; P .05) and clinical breast examination (6.1%; P.01) in women 50 years of age and older, particularly for those who had an HME during the study year.
Conclusions Patients who have HMEs are more likely to receive cancer screening; however, a computer-based system for preventive services can contribute to improvement in screening. Among those patients who did not have an HME, TSCS users had higher rates of breast cancer screening than nonusers.
From the Department of Family Practice, Medical College of Virginia, Virginia Commonwealth University, Richmond. Dr Williams is now affiliated with Ernst & Young, LLP, Richmond; Dr Boles, with the Department of Family Practice, the Center for Health Research, Kaiser Permanente Northwest Division, Portland, Ore.
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