Usefulness of a Checklist Form to Increase Preventive Health Maneuvers during Adult Health Examinations: The PERFORM* Randomized Controlled Trial *Preventive Health, Evidence-based, Recommendation Form

Vinita Dubey, BSc, MD, MPH¹, Roy Mathew, MD², R. Glazier, MD, MSc³, Rahim Moineddin, PhD², and Karl Iglar, MD². (1) Dept of Public Health Sciences, University of Toronto, c/o 1 Bluenose Crescent, Toronto, ON M1C 4R7, Canada, 416-286-0787/617-267-8165, vinita.dubey@utoronto.ca, (2) Dept of Family and Community Medicine, University of Toronto, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada, (3) St. Michael's Hospital, Toronto and the Department of Family Medicine, University of Toronto, 70 Richmond Street, Toronto, ON M5B 1W8, Canada

Objective: To determine the utility of a check-list reminder form to improve performance of preventive health care in a family practice setting. Design: Prospective cluster randomization controlled trial Setting and Participants: Four urban academic family practice clinics and 38 primary care physicians affiliated with the University of Toronto. Intervention: Preventive Care Checklist Forms„¦ were created incorporating recommendations from the Canadian Task Force on Preventive Health Care and documentation space for routine maneuvers such as functional inquiry and physical examination. The form was used by physicians at complete health assessments between November 2002 and March 2003 in intervention clinics. Main outcome measures: Rates and relative risks (RR) of 13 preventive health maneuvers at baseline and post-intervention and proportion of maneuvers per patient per group. Results: Randomly-selected charts were reviewed at baseline (n=509) and post-intervention (n=608). There was an overall 22.8% absolute increase (p=0.0001), and 46.6% relative increase in performance of preventive maneuvers per patient. Eight of thirteen maneuvers showed a statistically significant change (p<0.05) in favour of the intervention, including (adjusted RR): brushing/flossing teeth (9.2), folic acid counseling (7.5), fecal occult blood testing (6.7), smoking cessation (3.9), tetanus immunization (3.0), history of alcohol (1.33), history of smoking (1.28) and blood pressure measurement (1.05). Conclusions: This simple cost-effective intervention facilitates uptake into practice by making preventive care easier, by prompting physicians for recommendations that are difficult to remember, and incorporating billing requirements and practice patterns that are part of routine care. Periodic updates of the form will keep preventive primary care current and practical.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.