Computerised clinical reminders use in an integrated heathcare system

Objective: To examine levels of routine computerised clinical reminder use in a nationwide sample of primary care physicians and to identify factors influencing reminder use. Design: Cross-sectional using a self-administered questionnaire. Setting: The United States Veterans Health Administration. Methods: Survey responses from 461 VHA primary care physicians sampled from across the Veterans Health Administration were sampled and analysed. We asked physicians how many computerised clinical reminders they use per patient per visit and when they typically use computerised clinical reminders in their clinics. Measured physician characteristics included age, gender, year of medical degree, number of days in clinic per week, and attitudes towards computerised clinical reminders (measured on Likert-like scales). We used multivariable linear regression to determine factors associated with greater use of computerised clinical reminders per patient per visit. Results: Average computerised clinical reminder use per patient visit was 4.2 (SD = 2.5). Eighty-six percent of physicians resolve reminders during the visit. In a multivariable regression model, a higher score on the team factors scale is associated with use of more reminders (increase of 0.24 reminders for each unit increase on the team factors scale, or one extra reminder for each four unit increase in the team factor scale). Working more days in clinic is associated with use of more reminders per patient visit (increase of 0.13 reminders for each extra half-day of clinic per week, or about one additional reminder for physicians working ten half-days per week versus physicians working two half-days per week). Academic facility affiliation is associated with one less reminder used per patient visit as compared with no affiliation. Conclusions: Most United States Veterans Health Administration primary care physicians use computerised clinical reminders, typically during the patient visit. Strategies to increase reminder use should focus on improving physicians' understanding of their role in completing reminder-related tasks and improving usability for users such as physicians who work in clinic less frequently.