Point-of-Service reminders for prescribing cardiovascular medications

Am J Manag Care. 2005 May;11(5):298-304.


Objectives: To provide physicians with evidence-based recommendations for care at the point of service, using an automated system, and to evaluate its effectiveness in promoting prescriptions to prevent cardiovascular events.

Study design: Randomized controlled trial.

Methods: Patients at risk for cardiovascular events who might benefit from angiotensin-converting enzyme inhibitors or 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) were identified from electronic data in a managed care organization and randomly assigned into 2 groups. Physicians seeing outpatients in the intervention group were faxed a sheet with pertinent patient data, including a recommendation to prescribe the indicated medication. In the control group, the data sheet did not include the recommendation. Dispensed prescriptions were compared between groups.

Results: More than 4000 visits were observed for each medication type. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers were dispensed in 7.1% of visits in the intervention group versus 5.7% in the control group (P = .048) following the first patient-physician encounter. No significant difference was observed for statins (intervention, 8.1% vs control, 7.7%). Data for all patient-physician encounters and both medications were combined in logistic regression analysis. The odds ratio was 1.19 for a dispensed prescription in the intervention group and 1.54 for 2 or more visits versus 1 visit.

Conclusions: An automated system that provides pertinent data and tailored recommendations for care at the point of service modestly increased prescription dispensing rates. Targeting patient-provider encounters to change provider behavior is challenging; however, even small effects can produce clinically important results over time.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • California
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / drug therapy*
  • Diabetes Complications
  • Evidence-Based Medicine
  • Female
  • Humans
  • Male
  • Managed Care Programs
  • Middle Aged
  • Point-of-Care Systems*
  • Reminder Systems*