Impact of chart reminder flyers on the delivery of coronary primary preventive care in a randomized controlled trial

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of chart reminder flyers in increasing the appropriateness of coronary primary preventive care. DESIGN: Randomized controlled trial. SETTING: A university-based clinic in the period January-June, 2000. PATIENTS: 120 charts randomly selected from 256 patients in the intervention group were considered. Another 120 randomly chosen from 295 patients were selected for the control. These subjects were those who consulted from January-June 2000 at the university clinic. INTERVENTIONS: Each clinic day was randomized to be either "with reminder flyer day" or "without reminder flyer day." On "with reminder flyer days", a one-page flyer that contained a letter of reminder for physicians to perform coronary primary preventive care was placed on the charts of all patients consulting at the clinic. The reminder flyer was detached from the chart right after each consultation. On "without reminder flyers days", no intervention was done. At the end of the trial, 120 charts from each group were randomly selected for auditing for appropriateness of coronary primary preventive care. RESULTS: The proportions of charts that recorded appropriate history taking, physical examination and pharmacological and non-pharmacological interventions were all significantly greater in the intervention group than in the control group (p values 0.001, 0.005 and 0.0001). When coronary primary prevention was taken as a whole, the proportion of charts that reflected appropriate care was significantly greater in the intervention group than in the control group (25 percent vs. 5 percent, p 0.001). Reminder flyers reduced the relative risk of not being given appropriate coronary prevention to 0.79 (p, 0.001). MAIN OUTCOME MEASURES: Proportion of charts that documented appropriate primary coronary preventive care in the intervention and controlled groups were compared using the test for equality of proportions. The changes in appropriateness of the preventive care from baseline for each group was taken and compared. CONCLUSION: The proportion of charts that recorded appropriate coronary primary preventive care was significantly higher in the reminder flyer group.