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Systematic Review
This Cochrane review aimed: 1. To determine the effectiveness of manually‐generated reminders delivered on paper in changing professional practice and improving patient outcomes. 2. To explore whether a number of potential effect modifiers influence the effectiveness of manually‐generated reminders delivered on paper.
The reviewers identified 63 studies (41 cluster‐randomised trials, 18 individual randomised trials, and four non‐randomised trials) that met all inclusion criteria. Fifty‐seven studies reported usable data (64 comparisons). The studies were mainly located in North America (42 studies) and the UK (eight studies). Fifty‐four studies took place in outpatient/ambulatory settings. The clinical areas most commonly targeted were cardiovascular disease management (11 studies), cancer screening (10 studies) and preventive care (10 studies), and most studies had physicians as their target population (57 studies). General management of a clinical condition (17 studies), test‐ordering (14 studies) and prescription (10 studies) were the behaviours more commonly targeted by the intervention.
Forty‐eight studies reported changes in professional practice measured as dichotomous process adherence outcomes (e.g. compliance with guidelines recommendations), 16 reported those changes measured as continuous process‐of‐care outcomes (e.g. number of days with catheters), eight reported dichotomous patient outcomes (e.g. mortality rates) and five reported continuous patient outcomes (e.g. mean systolic blood pressure). Forty‐seven studies assessed the effect of reminders compared with control or usual care. In the studies assessing process adherence outcomes, only three of the effect estimates were related to recommended vaccination practices.
Manually‐generated reminders delivered on paper probably improve professional practice measured as dichotomous process adherence outcomes) compared with usual care (median improvement 8.45% [Inter quartile range (IQR) 2.54% to 20.58%].
Manually‐generated reminders delivered on paper as a single intervention probably lead to small to moderate increases in outcomes related to adherence to clinical recommendations, and they could be used as a single quality improvement (QI) intervention. It is uncertain whether reminders should be added to other QI intervention already in place in the health system, although the effects may be positive. If other QI interventions, such as patient or computerised reminders, are available, they should be preferred over manually‐generated reminders, but under close evaluation in order to decrease uncertainty about their potential effect.