Improving preventive service delivery at adult complete health check-ups: The Preventive health Evidence-based Recommendation Form (PERFORM) cluster randomized controlled trial

被引：58

作者：

Dubey V. ^{[1
]}

Mathew R. ^{[2
]}

Iglar K. ^{[2
]}

Moineddin R. ^{[3
]}

Glazier R. ^{[3
]}

机构：

[1] Dept. of Public Health Sciences, University of Toronto, Toronto, Ont. M1C 4R7

[2] Dept. of Family and Community Medicine, St. Michael's Hospital, Toronto, Ont. M5B 1W8

[3] Inner City Health Research Unit, University of Toronto, St. Michael's Hospital, Toronto, Ont. M5B 1W8

来源：

BMC Family Practice | / 7卷 / 1期

关键词：

Primary Care Physician; Preventive Service; Fecal Occult Blood Testing; Preventive Health; Mental Health Diagnosis;

D O I：

10.1186/1471-2296-7-44

中图分类号：

学科分类号：

摘要：

Background: To determine the effectiveness of a single checklist reminder form to improve the delivery of preventive health services at adult health check-ups in a family practice setting. Methods: A prospective cluster randomized controlled trial was conducted at four urban family practice clinics among 38 primary care physicians affiliated with the University of Toronto. Preventive Care Checklist Forms© were created to be used by family physicians at adult health check-ups over a five-month period. The sex-specific forms incorporate evidence-based recommendations on preventive health services and documentation space for routine procedures such as physical examination. The forms were used in two intervention clinics and two control clinics. Rates and relative risks (RR) of the performance of 13 preventive health maneuvers at baseline and post-intervention and the percentage of up-to-date preventive health services delivered per patient were compared between the two groups. Results: Randomly-selected charts were reviewed at baseline (n = 509) and post-intervention (n = 608). Baseline rates for provision of preventive health services ranged from 3% (fecal occult blood testing) to 93% (blood pressure measurement), similar to other settings. The percentage of up-to-date preventive health services delivered per patient at the end of the intervention was 48.9% in the control group and 71.7% in the intervention group. This is an overall 22.8% absolute increase (p = 0.0001), and 46.6% relative increase in the delivery of preventive health services per patient in the intervention group compared to controls. Eight of thirteen preventive health services showed a statistically significant change (p < 0.05) in favor of the intervention (adjusted RR (95% C.I.)): counseling on brushing/flossing teeth (9.2 (4.3-19.6)), folic acid counseling (7.5 (2.7-20.8)), fecal occult blood testing (6.7 (1.9-24.1)), smoking cessation counseling (3.9 (2.2-7.2)), tetanus immunization (3.0 (1.7-5.2)), history of alcohol intake (1.33 (1.2-1.5)), history of smoking habits (1.28 (1.2-1.4)) and blood pressure measurement (1.05 (1.00-1.10)). Conclusion: This simple, low cost, clinically relevant intervention improves the delivery of preventive health services by prompting physicians of evidence-based recommendations in a checklist format that incorporates existing practice patterns. Periodic updates of the Preventive Care Checklist Forms© will allow a feasible and easy-to-use tool for primary care physicians to provide evidence-based preventive health services to adults at routine health check-ups. The forms can also be incorporated into an electronic health record. The Preventive Care Checklist Forms© are accessible in English and French at the College of Family Physicians of Canada web site. © 2006 Dubey et al; licensee BioMed Central Ltd.

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