Table 1 Summary of results of CCDSS trials of primary preventive care
Study | Method Score | Indication | No. of centres/providers/patients | Process of care outcomes | CCDSS Effecta | Patient outcomes | CCDSS Effecta |
|---|---|---|---|---|---|---|---|
Cancer screening | |||||||
Sequist, 2009 [49] | 9 | Reminders to screen for colorectal cancer in primary care. | 11 / 110* / 21,860 | Individual tests performed: FOBT; Flexible sigmoidoscopy; Colonoscopy. | 0 | Pathologic findings: Colonic adenoma; Colorectal cancer. | 0 |
Emery, 2007 [30] | 10 | Recommendations for assessment and management of familial cancer risk in primary care. | 45* /.../ 219 | Appropriate referrals to regional genetics clinic. | + | Cancer worry score; Risk perception score; Accuracy of patient risk perception; Knowledge about familial cancer. | 0 |
Wilson, 2005 | 6 | Recommendations for referral and provision of information for breast cancer genetic risk in primary care. | 86* / 243 / 242 | Confidence in management of patients with family history of breast cancer concerns. | 0 | Perception of risk; Understanding of 'incorrect' breast cancer risk factors. | 0 |
Burack, 2003 [24] | 8 | Reminders for mammography and pap smear tests in primary care. | 3 / 20 / 2,471* | Primary care visit during study year; Mammogram completed during study year; Pap smear test completed during study year. | 0 | ... | ... |
Burack, 1998 [23] | 6 | Reminders to perform pap smear screening in primary care. | 3 / 20 / 5,801* | Patients with primary care visit; Patients with pap smear completed. | 0 | ... | ... |
Burack, 1997 [22] | 8 | Reminders for mammography in primary care. | 3 / 25 / 2,826* | Mammography completion rates. | + | ... | ... |
Burack, 1996 [21] | 8 | Reminders for mammography screening in primary care. | 2 / 20 / 2,368* | Primary care visit for women due for mammography; Mammography rates. | 0 | ... | ... |
Burack, 1994 [20] | 8 | Reminders for mammography in primary care. | 5 / 25 / 2,725* | Proportion of women with scheduled mammography appointments; Proportion of women having mammography. | + | ... | ... |
McPhee, 1991 [40] | 7 | Reminders for cancer screening and preventive counselling in primary care. | .../ 40* /... | Compliance with American Cancer Society and/or National Cancer Institute recommendations. | + | ... | ... |
McPhee, 1989 [39] | 7 | Reminders for cancer screening and preventive counselling in primary care. | 1 / 62* / 1,936 | Compliance with recommendations for FOBT, rectal exam, sigmoidoscopy, pap smear test, pelvic exam, breast exam, and mammography. | + | ... | ... |
Multiple preventive care activities | |||||||
Harari, 2008 [34] | 7 | Recommendations for primary preventative care and screening for functionally independent elderly patients in primary care. | 4 / 26 / 2,503* | BP check, FOBT (<80 years of age), influenza vaccination, dental check, vision check-up, or hearing check-up in previous year; Cholesterol measurement in previous five years (<75 years of age); Blood glucose measurement in previous three years; Pneumococcal vaccination (ever); Mammography in previous two years (<70 years of age). | 0 | Moderate or strenuous physical activity; Consumption of high fat food items; Consumption of fruit/fibre items; No current tobacco use; No or moderate alcohol use; Driving with use of seat belt. | 0 |
Apkon, 2005 [16] | 5 | Screening, preventive care, and recommendations for management of acute or chronic conditions for ambulatory care patients in military facilities. | 3 / 12 / 1,902* | Screening/prevention healthcare opportunities fulfilled; Acute/chronic healthcare opportunities (lipid abnormalities); Patient satisfaction. | 0 | Adverse events. | 0 |
Dexter, 2001 [29] | 10 | Reminders for preventive therapies in hospital inpatients. | ...* / 202 / 3,416 | Proportion of hospitalizations with an order for therapy (all patients and only eligible patients). | + | ... | ... |
Demakis, 2000 [28] | 7 | Reminders for screening, monitoring, and counselling in accordance with predefined standards of care in ambulatory care. | 12* / 275 / 12,989 | Per-patient and per-visit compliance with standards of care related to hypertension (weight, exercise, sodium), nutrition counselling for diabetes, and pneumococcal vaccination for elderly or high-risk patients. | + | ... | ... |
Overhage, 1996 [42] | 10 | Reminders to comply with 22 US Preventive Services Task Force preventive care measures for hospital inpatients. | 1* / 78 / 1,622 | Compliance with preventive care guidelines; Attitude towards providing preventive care to hospitalised patients. | 0 | ... | ... |
Frame, 1994 [33] | 6 | Reminders for cancer screening, CV disease preventive screening, identification of at-risk behavior, patient education, and vaccination in primary care. | 5 / 12 / 1,324* | Change in provider compliance with 11 health maintenance procedures over two years. | + | ... | ... |
Turner, 1994 [53] | 5 | Reminders for cancer screening and influenza vaccination in primary care. | 44* / 44 / 740 | Performance of health maintenance activities including influenza vaccinations, FOBTs, pap smears, breast exams, and mammography. | 0 | ... | ... |
Ornstein, 1991 [41] | 7 | Reminders for preventive care services for adults in family medicine clinic. | 1* / 49 / 7,397 | Proportion of patients who received each of five preventive services. | + for combined reminders 0 for physician or patient reminders | ... | ... |
Rosser, 1991 [46] | 6 | Reminders for cancer screening, BP measurement, assessment of smoking status, and vaccination in outpatients. | 1 /.../ 5,883* | Percentage of patients for whom the recommended procedures were performed. | + | ... | ... |
Tierney, 1986 [52] | 6 | Reminders of preventive care protocols for outpatients. | 1* / 135 / 6,045 | Physician compliance with preventive care protocols for fecal blood testing, pneumococcal vaccination, antacids, tuberculosis skin testing, calcium supplements, cervical cytology, mammography, and saclicylates. | + | ... | ... |
Screening and management of CV risk factors | |||||||
Bertoni, 2009 | 9 | Recommendations for screening and treatment of dyslipidaemia in primary care. | 59* / ... / 3,821 | Patients with appropriate lipid management at follow-up. | + | ... | ... |
Van Wyk, 2008 [56] | 10 | On-demand and automatic alerts to screen and treat dyslipidaemia in primary care. | 38* / 80 / 92,054 | Screening of appropriate patients. | Auto, + On-demand, 0 | ... | ... |
Unrod, 2007 | 8 | Recommendations to increase smoking cessation counselling and quit rates in primary care. | ... / 70* / 465 | Physician implementation of guideline including assessment and discussion of smoking behavior, support interventions for quitting, and referral to quit-smoking programs. | + | Seven-day point-prevalence for abstinence. | 0 |
Cobos, 2005 [27] | 10 | Recommendations for treatment, monitoring and follow-up for patients with dyslipidaemia in primary care. | 42* /.../ 2,221 | Treatment with lipid-lowering drugs in patients without coronary heart disease. | + | Successful management of patients without coronary heart disease. | 0 |
Kenealy, 2005 [35] | 10 | Reminders for screening for diabetes in outpatients. | 66* / 107 / 5,628 | Percentage of eligible patients visiting a practitioner and screened for diabetes. | + | ... | ... |
Filippi, 2003 [31] | 7 | Reminders to prescribe acetylsalicylic acid or other antiplatelet agents to diabetic primary care patients. | ... / 300* / 15,343 | Antiplatelet drug prescription for patients with cardiac risk factors but without CVD. | + | ... | ... |
Lowensteyn, 1998 [38] | 6 | Calculation of coronary risk factor profile for outpatients and identification of high-risk patients in primary care. | 24* / 253 / 958 | Ratio for high-risk/low-risk patients returning for reassessment at three months. | + | Total cholesterol; Total / high-density lipoprotein cholesterol ratio; Body mass index; High-density lipoprotein cholesterol; Low-density lipoprotein cholesterol; Systolic BP; Diastolic BP; Proportion of smokers; eight-year coronary risk; CV age. | + |
Rogers, 1984 | 4 | Detection of deficiencies in care and recommendations for the management of hypertension, obesity and renal disease in outpatients. | 1 / ... / 484* | Number of diets given or reviewed for obesity patients; Perceived quality of communication. | + | Perceived health status. | + |
Barnett, 1983 [17] | 4 | Reminders to follow-up patients with newly-identified elevated BP in an acute care setting. | 1 / ... / 115* | Patient follow-up attempted or achieved; Repeat BP measurement recorded. | + | Degree of BP control. | + |
Screening and management of mental health-related conditions | |||||||
Ahmad, 2009 [15] | 8 | Computer-assisted screening for intimate partner violence in primary care. | 1 / 11 / 314* | Opportunity to discuss possibility of risk for intimate partner violence; Detection of intimate partner violence when patient identified risk as being present and recent. | + | ... | ... |
Thomas, 2004 [51] | 7 | Identification and recommendations for management of anxiety and depression in outpatients. | 5 / ... / 762* | Patient satisfaction with general practitioner. | 0 | General Health Questionnaire score. | + |
Schriger, 2001 [48] | 8 | Provided computerized psychiatric interview and recommendations for patient diagnosis in the emergency department. | 1 / 104 / 259* | Proportion of patients assigned a psychiatric diagnosis by CCDSS who received a psychiatric diagnosis, consultation or referral in the emergency department. | 0 | ... | ... |
Cannon, 2000 [26] | 4 | Reminders for screening and diagnosis of mood disorder in an outpatient mental health clinic. | 1 / 4 / 78* | Proportion of patients screened for mood disorder; Proportion of major depressive disorder cases with fully documented diagnostic criteria (Diagnostic and Statistical Manual for Mental Disorders, 4 th edition). | + | ... | ... |
Lewis, 1996 [37] | 6 | Provided assessment for common mental disorders in primary care. | 1 / 8 / 681* | Consultations; Referrals to other professionals; Drug prescriptions. | 0 | Difference in General Health Questionnaire score. | 0 |
Rubenstein, 1995 [47] | 7 | Computer-generated feedback designed to identify and suggest management for functional deficits in primary care. | 2* / 73 / 557 | Clinical problems in medical records; Patients identified as having physical, psychological or social function impairments; Functional status interventions overall and for patients with functional status problems; Physician attitudes toward managing functional status. | ... | Patient functional status. | 0 |
Vaccinations | |||||||
Fiks, 2009 [1] | 8 | Alerts for influenza vaccination for children and adolescents with asthma in primary care. | 20* / ... / 11,919 | Captured opportunities for vaccination and up-to-date vaccination rates (adjusted analysis). | 0 | ... | ... |
Flanagan, 1999 [32] | 3 | Online reminders for tetanus, hepatitis, pneumococcal, measles, and influenza vaccinations for adults in primary care. | ... / 233* / 817 | Correct vaccine decisions. | 0 | ... | ... |
Chambers, 1991 [25] | 6 | Reminders for influenza vaccination in primary care. | 1 / 30* / 686 | Influenza vaccines given. | + for always reminders 0 for sometimes reminders | ... | ... |
Other preventive care activities | |||||||
Sundaram, 2009 [50] | 7 | Reminders for risk assessment and screening for HIV in primary care. | 5 / 32* / 26,042 | Change in HIV testing rates. | 0 | ... | ... |
Lafata, 2007 [36] | 9 | Reminders for osteoporosis screening for elderly, female outpatients in primary care. | 15* / 123 / 10,354 | Bone mineral density testing. | + | ... | ... |
Zanetti, 2003 [59] | 8 | Alert to redose prophylactic antibiotics during prolonged cardiac surgery. | 1 / ... / 447* | Intraoperative redose of antibiotics. | + | Surgical-site infection. | 0 |