The efficacy of computer reminders on external quality assessment for point-of-care testing in Danish general practice: rationale and methodology for two randomized trials

Frans B Waldorff, Volkert Siersma, Ruth Ertmann, Marius Brostrøm Kousgaard, Anette Sonne Nielsen, Peter Felding, Niels Mosbæk, Else Hjortsø, Susanne Reventlow, Frans B Waldorff, Volkert Siersma, Ruth Ertmann, Marius Brostrøm Kousgaard, Anette Sonne Nielsen, Peter Felding, Niels Mosbæk, Else Hjortsø, Susanne Reventlow

Abstract

Background: Point-of-care testing (POCT) is increasingly being used in general practice to assist general practitioners (GPs) in their management of patients with diseases. However, low adherence to quality guidelines in terms of split test procedures has been observed among GPs in parts of the Capital Region in Denmark. Computer reminders embedded in GPs electronic medical records (ComRem) may facilitate improved quality control behaviour, but more research is needed to identify what types of reminders work and when. The overall aim of this study is to evaluate the efficacy of ComRem to improve GPs adherence to quality guidelines. This article describes the rationale and methods of the study that constitute this research project.

Methods/design: The study is conducted as two randomised controlled trials (RCTs) among general practices in two districts of the Capital Region in Denmark. These districts contain a total of 739 GPs in 567 practices with a total of 1.1 million patients allocated to practice lists. In the first RCT (RCT A), ComRem is compared to postal reminder letters. In the second RCT (RCT B), ComRem is compared to usual activities (no reminders) with a crossover approach. In both of these studies, outcomes are measured by the number of split tests received by the laboratory.

Conclusions: This study will contribute to knowledge on the efficacy of ComRem in primary care. Because the study does not explore GPs' perceptions and experiences with regard to ComRem, we will subsequently conduct a qualitative survey focusing on these aspects.

Trial registrations: Study A: ClinicalTrials.gov identifier: NCT01152151Study B: ClinicalTrials.gov identifier: NCT01152177.

Figures

Figure 1
Figure 1
Contents of reminder (RCT A).
Figure 2
Figure 2
Trial flow for the project.

References

    1. Quality standards and quality assessment system for frequently performed clinical biochemistry and clinical microbiological tests in general practice. [Kvalitetskrav og kvalitetsvurderingssystem for hyppigt udførte klinisk biokemiske og klinisk mikrobiologiske analyser i almen praksis] Copenhagen: Danish College of General Practice; 2002.
    1. Wensing M, van der WT, Grol R. Implementing guidelines and innovations in general practice: which interventions are effective? Br J Gen Pract. 1998;48:991–997.
    1. Bro F, Waldorff FB. Guidelines--let's take a break and then move forward together! Scand J Prim Health Care. 2004;22:2–5. doi: 10.1080/02813430310004975.
    1. Waldorff FB, Almind G, Makela M, Moller S, Waldemar G. Implementation of a clinical dementia guideline. A controlled study on the effect of a multifaceted strategy. Scand J Prim Health Care. 2003;21:142–147. doi: 10.1080/02813430310005136.
    1. Wensing M, van der WT, Grol R. Implementing guidelines and innovations in general practice: which interventions are effective? Br J Gen Pract. 1998;48:991–997.
    1. Oxman AD, Thomson MA, Davis DA, Haynes RB. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ. 1995;153:1423–1431.
    1. Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L. et al.Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8:iii–72.
    1. Shojania KG, Ranji SR, McDonald KM, Grimshaw JM, Sundaram V, Rushakoff RJ. et al.Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA. 2006;296:427–440. doi: 10.1001/jama.296.4.427.
    1. Fretheim A, Schunemann HJ, Oxman AD. Improving the use of research evidence in guideline development: 15. Disseminating and implementing guidelines. Health Res Policy Syst. 2006;4:27. doi: 10.1186/1478-4505-4-27.
    1. Dexheimer JW, Talbot TR, Sanders DL, Rosenbloom ST, Aronsky D. Prompting clinicians about preventive care measures: a systematic review of randomized controlled trials. J Am Med Inform Assoc. 2008;15:311–320. doi: 10.1197/jamia.M2555.
    1. Garg AK. Automating communication: using technology to increase effectiveness and profitability. Dent Implantol Update. 2007;18:89–92.
    1. Kawamoto K, Lobach DF. Clinical decision support provided within physician order entry systems: a systematic review of features effective for changing clinician behavior. AMIA Annu Symp Proc. 2003. pp. 361–365.
    1. Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev. 2009. p. CD001096.
    1. Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ. et al.CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869. doi: 10.1136/bmj.c869.
    1. Waldorff FB, Siersma V, Nielsen B, Steenstrup AP, Bro F. The effect of reminder letters on the uptake of an e-learning programme on dementia: a randomized trial in general practice. Fam Pract. 2009;26:466–471. doi: 10.1093/fampra/cmp072.
    1. Kvale S. InterViews: An introduction to qualitative research interviewing. Thousand Oaks: Sage; 1996.
    1. O'Cathain A. Mixed Methods Research in the Health Sciences: A Quiet Revolution. Journal of Mixed Methods Research. 2009. pp. 3–6.
    1. Lewin S, Glenton C, Oxman AD. Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study. BMJ. 2009;339:b3496. doi: 10.1136/bmj.b3496.
    1. Patton MQ. Qualitative Research & Evaluation Methods. 3. Thousand Oaks: Sage; 2002.

Source: PubMed

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