Reminder Cards Research Articles

Aiming to increase birth weight: a randomised trial of pre-pregnancy information, advice and counselling in inner-urban Melbourne

BackgroundIn the 1980s there was substantial interest in early pregnancy and pre-pregnancy interventions to increase birth weight and reduce preterm birth. We developed an inter-pregnancy intervention, implemented in a randomised controlled trial, to be provided by midwives at home soon after women's first birth.MethodsMCH nurses invited women to take part during their home visit to new mothers. Women's contact details, with their permission, were passed to the study midwife. She had a randomisation schedule to which women's names were added before she met the women or their partners. All women recruited had a home visit from the study midwife with a discussion of their first pregnancy, labour and birth and the postpartum experience. Women in the intervention arm received in addition a pre-pregnancy intervention with discussion of social, health or lifestyle problems, preparation and timing for pregnancy, family history, rubella immunisation, referrals for health problems, and a reminder card. The primary outcome was defined as a birth weight difference in the second birth of 100 g (one-sided) in favour of the intervention. Additional data collected were gestational age, perinatal deaths and birth defects. Analyses used EPI-INFO and STATA.ResultsIntervention and comparison groups were comparable on socioeconomic factors, prior reproductive history and first birth outcomes. Infant birth weight in the second birth was lower (-97.4 g,)) among infants in the intervention arm. There were no significant differences between intervention and comparison arms in the proportion of women having a preterm birth, an infant with low birthweight, or an infant with a birth weight <10th percentile. There were more adverse outcomes in the intervention arm: ten births <32 weeks), compared with one in standard care, and more infants with a birth weight <2000 g, 16 compared with two in standard careConclusionAs the primary outcome was envisaged to be either improved birth weight or no effect, the study was not designed to identify the alternative outcome with confidence. Despite widespread support for pre-pregnancy interventions to improve maternal and perinatal health, this first randomised controlled trial of a multi-component intervention provided at home, did not have a beneficial outcome.

Physician experience with family presence during cardiopulmonary resuscitation in children*

Family presence during cardiopulmonary resuscitation in children is an emerging practice. Although many hospitals allow this practice, there is scant research on physician attitudes and opinions and on physician views about training for resident physicians. Survey method. University and community settings. We randomly selected 1,200 pediatric critical care and emergency medicine providers from professional association mailing lists. The providers were mailed up to two written surveys and two reminder cards. The survey consisted of 40 multiple-choice and short-answer questions about demographics, past experiences, and opinions on pediatric family presence. Of 1,200 surveys mailed, 521 were completed (43.4%) and 73 (6.1%) respondents returned the form declining to participate. More than 99% of respondents were physicians. Four hundred and thirty-three respondents (83%) reported participation in pediatric resuscitation with family members present, with a mean of 15 episodes ever and three episodes within the last year. Of those who had ever participated, more than half thought it was helpful for the family, and two thirds believed that parents wanted the option. Ninety-three percent would allow family presence in some situations. Seventy-four percent believed family presence would be stressful for a resident physician, but nearly 80% believed that residents working with children should be educated in this area. Family presence during cardiopulmonary resuscitation in children is not an uncommon experience for health care providers. Most respondents had resuscitated a child with family members present. The majority thought that presence was helpful to parents and that residents should be trained in this practice.

Initial nonresponders had an increased response rate after repeated questionnaire mailings

Background and Objective There is a growing evidence base on methods to improve response rates in surveys among patients. This study aimed to determine the additional effect of two intensive follow-up procedures compared to a simple follow-up procedure. Methods Randomized controlled trial that compared repeated mailing of the questionnaire and a request to explain nonparticipation with a simple reminder card. The study population comprised 955 elderly adults registered with 26 general practitioners in The Netherlands. Results A total of 530 adults (56%) returned the questionnaire within 3 weeks and a total of 640 (67%) after follow-up. Repeated mailing of the questionnaire had additional effect compared to the simple reminder card in the group of initial nonresponders (relative risk = 1.60, 95% confidence interval: 1.11–2.31), but not regarding the overall response rate. A request to explain nonparticipation did not have additional effect. Conclusion Repeated mailing of the questionnaire increased the effectiveness of follow-up among initial nonresponders.

Observational study of consumer role and awareness in checking medications

ISSUE: Medication errors are the single most common type of adverse event. The Institute for Safe Medication Practices reported in 2002 that one out of every 20 prescriptions filled in a pharmacy has an error. While many hospitals and pharmacies are trying to reduce the prevalence of medication errors in a variety of ways, consumers must take an active role in protecting themselves from potential errors of this kind. Therefore, we evaluated how actively involved consumers are in protecting themselves against medication errors by observing their behavior when picking up prescriptions. PROJECT: Observed all individuals who came to pick up a prescription at a specific selection of pharmacies in and around an urban academic institution. By blending into the waiting area, we noted a selection of characteristics about each consumer including: gender, age, race, whether the consumer looked in his medicine bag during the time in which he was visible to us, whether the consumer asked questions of the pharmacist, whether the pharmacist asked the consumer if he had any questions, and whether there were any other significant, distinguishing characteristics about each interaction. RESULTS: The sample size for this study consisted of 220 observed interactions. Fourteen percent (14%) of observed consumers looked in their medicine bags before leaving the pharmacy, and 18% of observed consumers asked medication questions of their pharmacist. Some pharmacists were better than others about actively asking consumers if they had any questions about their medication. Overall, 23% of observed pharmacists asked the consumers if they had any questions about their medication. Other factors such as workload and the number of other pharmacists available influenced whether or not the pharmacists engaged with the consumers and whether or not the consumers had a chance to ask questions. LESSONS LEARNED: The majority of observed consumers did not play an active role in preventing medication errors, suggesting a need for a new, more active protocol to get the average consumer more interested in their own healthcare. A simple reminder poster or card on the counter where the interaction between the pharmacist and consumer takes place may decrease medication errors.

Tennessee's Novice Driver Safety Project: A Program to Increase Parental Involvement

Graduated licensing has been implemented in many U.S. states to reduce teenage driver crash involvement. The goal is to introduce teenagers gradually to driving before allowing full, unrestricted licensure. Tennessee, one of the states that introduced graduated licensing, implemented a program to influence both driving by teenagers during the learner stage and restrictions imposed by parents after licensure. In addition to a standard welcome letter, booklets and reminder cards were mailed to parents of teenagers who had just obtained their learner's permits. The booklets and cards were designed to assist parents in becoming more actively involved in their children's driving experiences. The effects of three different approaches (welcome letter only, letter plus booklet, and letter plus booklet plus reminder cards) on parental involvement, teenage crashes, and teenage citations were assessed based on telephone interviews with parents. Although the parents said the booklets and reminder cards were helpful and should continue to be sent to other parents, there were no discernible effects on teenage practice driving and reported parental involvement during the learner stage. Nor was there any measurable influence on restrictions imposed by parents after licensure. It is unknown whether the standard welcome letter affected parental involvement, but overall supervised driving exceeded the state requirements by a substantial margin.

Limited Impact of a Multicenter Intervention To Improve the Quality and Efficiency of Pneumonia Care

To evaluate the impact of a multifactorial intervention to improve the quality, efficiency, and patient understanding of care for community-acquired pneumonia. Times series cohort study. Four academic health centers in the New York City metropolitan area. All consecutive adults hospitalized for pneumonia during a 5-month period before (n = 1,013) and after (n = 1,081) implementation of an inpatient quality improvement (QI) initiative. A multidisciplinary team of opinion leaders developed evidence-based treatment guidelines and critical pathways, conducted educational sessions with physicians, distributed pocket reminder cards, promoted standardized orders, and developed bilingual patient education materials. The average age was 71.4 years, and 44.1% of cases were low risk, 36.8% were moderate risk, and 19.2% were high risk. The preintervention and postintervention groups were well matched on age, sex, race, nursing home residence, pneumonia severity, initial presentation, and most major comorbidities. The intervention increased the use of guideline-recommended antimicrobial therapy from 78.1 to 83.4% (p = 0.003). There was also a borderline decrease in the proportion of patients being discharged prior to becoming clinically stable, from 27.0 to 23.5% (p = 0.06). However, there were no improvements in the other targeted indicators, including time to first dose of antibiotics, proportion receiving antibiotics within 8 h, timely switch to oral antibiotics, timely discharge, length of stay, or patient education outcomes. This real-world QI program was able to improve modestly on some quality indicators, but not effect resource use or patient knowledge of their disease. Changing physician and organizational behavior in academic health centers will require the development and implementation of more intensive, system-oriented strategies.

A Survey of Canadian Practitioners Regarding the Management of the Hypertensive Disorders of Pregnancy

Background: How Canadian practitioners are managing the hypertensive disorders of pregnancy (HDP) is not known, particularly in relation to the 1997 guidelines published by the Canadian Hypertension Society (CHS). Methods: A survey, with French and English versions (and covering diagnosis, evaluation, and management of pregnancy hypertension), was mailed to all members of the Society of Obstetricians and Gynaecologists of Canada (SOGC) (N = 1757, including obstetricians, family doctors practicing obstetrics, and midwives). Additionally, internists [i.e., all nephrologists (N = 191) and a random sample of 25% of general internists (N = 450)] registered with the Royal College of Physicians and Surgeons of Canada were sampled. The survey was distributed in two mailings and one reminder card. Data were entered into Microsoft Access, and Graph Pad Prism used to summarize responses [N (%)]. Differences in practice between specialties were examined, with a Bonferroni correction used to calculate a significant p value based on the number of comparisons and alpha of 0.05. Results: Respondents numbered 1187 (49.5%), with 466 not informative for the purpose of the study (due to retirement, or practices that do not include pregnant women with hypertension). The final analysis included 721 completed surveys. For all types of HDP, most internists, family doctors, and midwives initiate nonpharmacological therapy (most common advice to quit work) at dBP 80–89 mmHg (i.e., primary prevention). Only for preeclampsia do obstetricians most frequently use this threshold; otherwise, dBP 90–99 mmHg is usually chosen. For nonsevere hypertension, antihypertensive drug therapy (most commonly methyldopa or labetalol) is started by most practitioners at dBP 90–99 mmHg, although obstetricians are more likely to choose a higher threshold (p < 0.0001). There is little agreement about dBP treatment goal; most internists and family doctors normalize dBP, whereas obstetricians appear to be divided on dBP goals of 80–89 (46–51%) vs. 90–99 mmHg (41–44%) for all HDP (p = 0.66). Severe hypertension is commonly treated with parenteral hydralazine, labetalol, or magnesium sulphate. Short‐acting or sustained release nifedipine is used rarely/never by most practitioners. Approximately one‐third of obstetricians and family doctors use diazepam to treat eclampsia. The vast majority use MgSO4 prophylactically in women with preeclampsia. Interpretation: This survey has clarified current stated management of women with HDP, and identified the need for both research into the dBP treatment goal that optimizes pregnancy outcomes among women with HDP, and translation of definitive studies into clinical practice.

A Survey of Canadian Practitioners Regarding Diagnosis and Evaluation of the Hypertensive Disorders of Pregnancy

Background: How Canadian practitioners are diagnosing and managing the hypertensive disorders of pregnancy (HDP), particularly in relation to the 1997 recommendations published by the Canadian Hypertension Society (CHS), is not known. Methods: A survey, with French and English versions (and covering diagnosis, evaluation, and management of pregnancy hypertension), was mailed to all members of the Society of Obstetricians and Gynaecologists of Canada (SOGC) (N = 1757, including obstetricians, family doctors practicing obstetrics, and midwives). Additionally, internists [i.e., all nephrologists (N = 191) and a random sample of 25% of general internists (N = 450)] registered with the Royal College of Physicians and Surgeons of Canada were sampled. The survey was distributed in two mailings and one reminder card. Data were entered into Microsoft Access, and Graph Pad Prism used to summarize responses [N (%)]. Differences in practice between specialties were examined, with a Bonferonni correction used to calculate a significant p value based on the number of comparisons and alpha of 0.05. Results: Respondents numbered 1187 (49.5%), with 466 not informative for the purpose of the study (due to retirement, or practices that do not include pregnant women with hypertension). The final analysis included 721 completed surveys. Most (609, 84.5% of) respondents take blood pressure (BP) with women in the sitting position, and use a mercury sphygmomanometer (79%) and the 5th Korotkoff (61%) sound to designate diastolic BP (dBP). To monitor pregnancies complicated by preeclampsia, most clinicians use the proposed laboratory tests of maternal well‐being (usually at least once/week), fetal well‐being [nonstress test (NST, at least once/week), and ultrasonographic studies (once weekly to every two weeks)]. There is general agreement that women with preeclampsia should be delivered for uncontrolled hypertension, end‐organ dysfunction, or fetal compromise (nonreassuring NST, severe oligohydramnios, biophysical profile < 4, estimated fetal weight < 5th centile, and reversed end‐diastolic flow by umbilical artery Doppler velocimetry). Less consensus was seen for delivery for preeclampsia at > 34 weeks, mild asymptomatic HELLP syndrome, hyperreflexia, and absent end‐diastolic flow by umbilical artery Doppler velocimetry. Interpretation: This survey has clarified the current state of practice with respect to the diagnosis and evaluation of women with all types of HDP. In particular, we have identified areas of potential variability in BP measurement, and provided data on the feasibility of enrolling women with sub types of preeclampsia into intervention studies aimed at prolonging pregnancy.

The Delta project: increasing breast cancer screening among rural minority and older women by targeting rural healthcare providers.

To test a multimethod approach designed for rural healthcare providers to increase breast cancer screening among low-income, African American, and older women. Two-year experimental pretest/post-test with random assignment by group. Primary healthcare providers' offices. 224 nurses, physicians, and mammography technicians. Standardized patients to observe and record healthcare providers' performances, followed by direct feedback, newsletters, posters, pocket reminder cards, and lay literature about screening to use in clinics. Healthcare providers' knowledge and attitudes as measured by survey responses, skills as measured by a checklist, and the provision of breast cancer screening as measured by mammography facilities' data. Healthcare providers significantly improved in demonstration of breast cancer screening practice after the intervention. Nurses performed significantly better than physicians on the breast examination during the post-test. More women older than 50 received mammograms in the experimental counties than in the comparison counties. Culturally sensitive lay literature is needed for African American women with low literacy. Successful interventions included use of standardized patients to teach healthcare providers in their office settings, prompts such as posters and pocket reminder cards, and easy-to-read newsletters. Physicians and nurses play a powerful role in motivating women to have mammograms and clinical breast examinations and to practice breast self-examination. Interventions that help these providers fulfill that role should be implemented.

Improving compliance in oral contraception: 'the reminder card'

Improving compliance in oral contraception: 'the reminder card'

Teaching persons with severe mental disabilities to be their own case managers.

Teaching persons with severe mental disabilities to be their own case managers.

Improving compliance in oral contraception: 'the reminder card'

Objectives: To assess oral contraceptive compliance and to evaluate the reminder card device as a means of improving compliance. The study also aimed to evaluate ease of use of the card and women'sattitudes to it after several months of use.Methods: In France, 975 women requesting oral contraception (whether repeat prescription or first-time use) were asked retrospectively about missedpills during the previous 3 or 6 months. The decision of whether or not to provide a patient with a reminder card at inclusion was left to the gynecologist. Usefulness of and satisfaction with the remindercard were also assessed.Results: Of all study participants, 60% acknowledged missing at least one pill since starting oral contraception. Compliance appeared to be significantly better in cardusers than non-users (p < 0.001). More than 80% of card users stated that the device had prevented them from forgetting to take the pill on at least one occasion. Forty-six per cent of preventedmissed pills occurred during the first week of the cycle. No pregnancies were recorded. Among the card users, 98% found the card easy to use and 97% were satisfied with the card.Conclusions:Use of the reminder card significantly improved compliance. Users found the reminder card acceptable and easy to use. This type of reminder device could potentially reduce the number of unwanted pregnanciesand hence the number of requests for pregnancy termination.

Depression Program Promising In Primary Care Settings

Depression Program Promising In Primary Care Settings

The use of public education in practice.

1. Miriam E. Bar-on, MD* 1. 2. *Professor of Pediatrics, Ronald McDonald Children’s Hospital, Loyola University Stritch School of Medicine, Maywood, IL Dr Bar-on also is Chair, Committee on Public Education, American Academy of Pediatrics. Objectives After completing this article, readers should be able to: 1. Describe the primary goals of patient handouts. 2. Describe the primary goals of group education for patients who have specific disease processes. 3. Delineate the advantages of pediatrician involvement in the community. 4. Describe quality issues related to patient education on the Internet. 5. List the advantages of developing media contacts and providing information to them. Public or patient education is one means of attaining the optimal physical, mental, and social health and well-being for infants, children, adolescents, and young adults, as stated in the American Academy of Pediatrics’ (AAP) mission statement. By definition, patient education is the process of influencing patient behavior and producing changes in knowledge, attitudes, and skills required to maintain or improve health. This usually is addressed on an individual basis and includes teaching and counseling to enable patients to stay healthy and manage illness better when it occurs. Public education, on the other hand, is a broader term that includes the pediatrician’s role in influencing the health status of the public through involvement with community groups and the media. Both types of education are important and merit pediatrician involvement. Questions arise as to the best and most effective ways to provide this education within the constraints of busy practices or other commitments. Public education can be incorporated into pediatricians’ daily activities in a variety of ways both inside and outside the office. Studies in the medical literature have reviewed the outcomes of public/patient education programs and their effectiveness in practice. This article examines various methods of public/patient education that may enhance pediatricians’ promotion of health and well-being for their patients. Although many of the methods discussed will be familiar, there is evidence in the literature that public/patient education is not adequately provided to patients. The office is the primary …

Pilot intervention to improve the documentation of pediatric injuries in the emergency department

Our goal was to determine the effectiveness of an intervention aimed at improving the emergency department (ED) documentation of pediatric injuries. All physicians and nursing staff in the ED of an urban teaching hospital and trauma centre underwent focused injury surveillance training and were instructed how to document 14 injury-specific data elements. Pocket reminder cards were provided, and pediatric injury charts were flagged. Subsequently, random samples of pediatric injury charts were analyzed from a 3-month period prior to the intervention and from the corresponding months after the intervention. Post-intervention documentation was compared to pre-intervention documentation for the 14 pre-defined data elements. Six of the 14 data elements were charted more frequently, and 2 less frequently during the post-intervention phase. Odds ratios ranged from 4.59 (95%CI, 3.40 to 6.19) for charting "the presence of an adult observer" to 0.09 (95%CI, 0.01 to 0.76) for charting "sports equipment related to the injury." The "flagging" of injury charts, as a visual reminder for clinicians to document injury data, seemed to be the most effective component of the intervention. A simple intervention, consisting of staff training, chart modification, and visual flagging of charts, can increase the amount of injury information documented by ED clinicians. Efforts to improve ED charting are most likely to succeed if they include visual prompts for clinicians.

Behavior Change Among Agents of a Community Safety Program

Pizza deliverers served as intervention agents for a community safety belt campaign sponsored by their store. The program consisted of local radio and newspaper promotions, safety belt reminder cards pasted to the boxtops of each pizza sold, free pizza giveaways to customers who displayed safety belt reminder cards (from the box-top) on their rearview mirror, and dollar-off coupons to patrons who asked the dispatcher to remind the deliverer to buckle up when delivering their pizza. Safety belt use among deliverers rose 32% over baseline during the intervention. Turn signal use among the same deliverers increased 41% over baseline suggesting response generalization. Increases in safety belt and turn signal use were maintained up to 24 weeks after the conclusion of the intervention. Deliverers at a control site did not show concomitant increases in safety belt or turn signal use. Social validity interviews indicated that 58% of the general public contacted by phone would be more likely to use their safety belt because of the community program.

Interventions to enhance cancer screening

Although major advances have been made in the proportion of women who have been screened for breast and cervical cancer, there are still large numbers of women who are not being screened on schedule. This article includes a very selective review of types of interventions that have been used to increase cancer screening. These include the following kinds of interventions: mass media, patient-directed, provider- and system-directed, access-enhancing, community-directed, policy level, and multilevel interventions. Several different kinds of interventions have been used to increase cancer screening. The most extensive research has been conducted in the areas of breast and cervical cancer screening. Some relatively simple and inexpensive interventions have been shown to double or triple the odds that women will get screened; these include simple reminder letters or cards and telephone counseling. Tailored interventions are a new area and hold promise. Some studies have shown the value of access-enhancing strategies, such as the use of mobile vans. Policy changes are necessary but are not sufficient to increase the use of screening. One of the challenges for the future is to reach the groups in the population that have remained resistant to screening despite numerous messages in the mass media. The interventions of the future should reflect what has been learned in the past, such as the importance of reminders and cues to screening and overcoming women's barriers through strategies, such as counseling. However, tomorrow's interventions also should take advantage of digital technology and other advances in communications, and interventions should be tailored to the special needs of individuals in ways that are responsive to their learning preferences, situational constraints, and life styles. Far more research is needed to address the heterogeneity of minority populations in the United States and elsewhere. At present, it is not known to what extent interventions tested among black populations will extend to other minorities.

Nutrition Education, Computer, and Internet Practices of Missouri Teachers

A survey was administered to a random sample of 441 Missouri educators to determine the status of nutrition education in Missouri schools, as well as computer and Internet use by Missouri teachers. The educators included elementary and secondary school teachers and other school staff who reported teaching nutrition education. The survey obtained information about the educators’ demographics, computer and Internet access and use, and nutrition education practices in the classroom. A reminder card was mailed and telephone follow-up conducted with non-respondents. A response rate of 34% (n=149) was achieved. Data analysis was conducted using the Statistical Analysis System (SAS). Females comprised 91% of the respondents. Respondents taught a median of 5 hours of nutrition during a school year. Forty-eight percent thought that teaching nutrition was very important but said that they find it hard to teach nutrition because they have no time (62%) or resources (27%). Most of the respondents got their nutrition information from textbooks (54%), associations such as the National Dairy Council (47%), and governmental agencies (47%). Only 13% obtained nutrition information from the Internet. Although 87% of the educators did not use the Internet to obtain nutrition resources, 76% said they were interested in learning how to do so. The respondents generally felt comfortable using a computer, but did not feel as comfortable using the Internet. The majority of schools have had Internet access for an average of 2 years. The survey results indicate that the Internet may be a useful tool for providing needed nutrition education resources to school teachers. Teachers may need more training to feel comfortable using the Internet to find nutrition education resources.

Randomised controlled trial of the use of a modified postal reminder card on the uptake of measles vaccination

OBJECTIVETo determine whether rewording postal reminder cards according to the “health belief model”, a theory about preventive health behaviour, would help to improve measles vaccination rates.DESIGNA randomised controlled trial, with...

Randomised controlled trial of reminders to enhance the impact of audit in general practice on management of patients who use benzodiazepines.

OBJECTIVE: To determine whether reminder cards in medical records enhance the effectiveness of audit with feedback in improving the care of patients taking long term benzodiazepine drugs. DESIGN: Randomised trial,...