PURPOSE: Point of care reminders have been reported to improve pneumonia patient care (Weingarten). However clinical reminders have not been uniformally effective in implementing beta-blocker guidelines (Ansari) or in improving HIV care (Patterson). Even with an integrated, mature clinical reminder process, improvements are often limited and quality gaps remain (Sequist, Bates). Explicitly assigning responsibility for reminders to individuals may increase user acceptance (GAPS). This study aimed to evaluate whether physicians report a different response to reminders from different sources. The results were used to implement clinical reminders for pneumonia care.
METHODS: In December of 2002, 311 internal medicine offices were surveyed by fax regarding their opinions about types and sources of reminders. 152 offices responded to faxed questionnaires (48.9% of offices responding.). The questionnaire asked for “favorable”, “neutral” or “unfavorable” ratings of types and sources of reminders. Spearman correlations of sources and types of reminders were performed.
RESULTS: Sources of reminders rated “favorable” included pharmacists (78.2%), attending physicians (77.8%), nurses (64.1%), and residents (16.8%). When a reminder originated from an administrative source, physicians responded with an unfavorable ratings (40.6%). Physicians rated “favorable” reminders that were chart-based (71.0%), automated (59.4%), and in order sets (59.0%). “Unfavorable” types of reminders included email (40.8% rated “unfavorable”), traditional letters (32.6%) and telephone calls (40.0%). For one group, pharmacists, a significant, positive relationship was found for chart-based reminders (R 0.41, p<0.0001).
CONCLUSION: Physicians in a medical staff of a large teaching hospital reported preferences for clinical reminders from clinical sources, especially colleagues and pharmacists. Also preferred were chart based reminders, automated reminders and order sets with embedded reminders. When coming from an administrative source, clinical reminders received “unfavorable” ratings.
CLINICAL IMPLICATIONS: The findings of this qualitative analysis of medical staff preferences may be useful to select preferred routes and sources of future clinical quality reminders. While this adds to the evidence on academic detailing, more research is needed to explore the best avenues for conveying clinical quality information to physicians.
DISCLOSURE: Dani Hackner, No Financial Disclosure Information; No Product/Research Disclosure Information