McDowell I et al. 1989 "A randomized trial of computerized reminders for blood-pressure screening in primary care."

McDowell I, Newell C, Rosser W. A randomized trial of computerized reminders for blood-pressure screening in primary care. Med Care 1989;27(3):297-305.
"In a randomized, controlled trial (N = 8,298) the authors compared three ways of encouraging patients in a large family practice to obtain a blood pressure check. Working from computerized medical records at a teaching family-medicine center, the study included patients aged 18 years and over who had not had a blood pressure measurement during the previous year. In a normal-care control group, 21.1% of those due for a blood pressure reading obtained one during the trial year. In one intervention group, a computer-generated message reminded the doctor to check the blood pressure of patients who happened to visit the center for an appointment; 30.7% of patients allocated to this group were checked. In the second group, the nurse contacted patients by telephone and encouraged 24.1% of those who were due for a check to obtain one. Sending a letter to patients in the third group yielded a 35.7% compliance rate. Considering the costs of the three interventions, the physician reminder was the most cost effective, followed by the letter reminder. Although statistically significant, the impact of the reminders was modest. A better approach might involve a combination of routine reminders to the physician, followed by letters to noncompliant patients."
To "[compare] three ways of encouraging patients in a large family practice to obtain a blood pressure check," computer-generated reminders to physicians, nurse phone calls to patients and letters mailed to patients.
Type Clinic
Primary care
Type Specific
Family practice
Other Information
The study location was the Family Medicine Center at the Ottawa Civic Hospital, in Ottawa, Canada.
Type of Health IT
Computerized clinical reminders (CRs) and alerts
Type of Health IT Functions
A reminder was printed from the computer and given to the physician at the time of the patient visit, advising the physician to check the patient's blood pressure.
Context or other IT in place
An electronic health record (EHR) system that includes diagnoses, prescriptions, treatment and billing information was already in place.
Workflow-Related Findings
Thirty-one percent of patients in the group with the physician reminders had their blood pressure checked, compared to 21 percent of patients in the control group, 36 percent of patients in the letter group and 24 percent of patients in the phone group.
"To verify the physicians' recording of blood pressure readings, we [observed] 20 visits for which a reminder was issued. For three patients the reminder was not acted upon; for 14 patients, a reading was taken and recorded. A reading was taken but not recorded in three visits, suggesting an under-recording of 18%." In some cases the reading was recorded in the paper chart but was not entered into the computer.
"The [computer system to generate reminders] was efficient and accepted by the staff."
Study Design
Randomized controlled trial (RCT)
Study Participants
A total of 8,298 patients took part in the study. The three experimental groups were assigned to different methods of issuing reminders for a blood pressure check: (1) letter reminders, printed by the computer and signed by the physician and nurse; (2) telephone reminders, in which a list of patients was generated by the computer, then the patients were called by nurses; and (3) physician reminders, where the physician received a printed reminder from the computer advising them to "check blood pressure." Entire families of patients were randomized into the experimental groups.