September, 2009 - SUPPORT Summary of a systematic review | print this article |

Does prompting physicians improve performance in preventive care?

Physicians prompts can be defined as different mechanisms designed to periodically remind them to perform some action(s) with their patients in order to achieve some defined objective(s) or clinical outcomes, such as the delivery of preventive interventions.

Key messages


  • All the studies were done in high income countries which constitute a limitation to the application of the findings to low and middle-income countries.
  • Prompting physicians probably can improve performance in preventive care. This includes different preventive procedures such as faecal blood occult test, mammogram, PAP smear, influenza, tetanus and pneumonia vaccination, among others.
  • Both computer and non-computer generated prompts may improve performance in preventive care.
  • There is a lack of cost-effectiveness studies comparing different ways of generating and/or delivering the prompts.
  • Access to preventive services is a requisite for the effectiveness of this kind of interventions. Therefore, coverage of preventive services should be considered when implementing them.


Health systems are encouraging organizations and individual physicians to use every episode of patient care to promote health maintenance. Physician prompts –defined as the different mechanisms destined to periodically remind the clinician to perform some action(s) with their patients– have been used with this aim. They are delivered before a scheduled encounter, can be presented in different formats, be computer or noncomputer generated and can contain a variety of information for the physicians, such as patient name and/or diagnosis, notice of deviation from standard, criteria for procedures or tests and recommendation for treatment, indication of upcoming or previous procedures or tests, space for clinician to indicate that the procedure or test was offered or why it was not offered. There is no specification in the review about what actions are involved in the non-computer generated prompts.

About the systematic review underlying this summary

Summary of findings

The review included 33 studies, with data on 1,547 physicians and 54,693 patients. All the studies were RCTs and were done in high-income settings (mostly the USA). It included preventive procedures related to cancer screening (faecal occult blood, mammography, Papanicolaou smear); immunization (influenza, pneumococcal, tetanus); diabetes, cholesterol, hemoglobin and blood pressure management and follow-up; cardiac care, smoking cessation, glaucoma screening, alcohol abuse counseling, prenatal care, and tuberculosis testing.

1) Prompts compared with no prompts to physicians

The 33 studies identified reported this comparison. In 13 studies (27,889 patients; 51% of the total) patients were reminded in addition to physicians.

  • Prompting physicians probably improves the performance of preventive care actions by patients.
  • There was not enough data to estimate the total costs of the intervention.


2) Computer-generated prompts compared with no prompts

25 studies assessed this comparison. In 11 studies (27,387 patients; 54,7% of the total) patients were reminded in addition to physicians.

  • Computer-generated prompts probably improve the performance in preventive care.



3) Non-computer generated prompts compared with no prompts

8 studies assessed this comparison. In 2 studies (659 patients; 14,2% of the total) patients were reminded in addition to physicians.

  • Non-computer generated prompts may improve the performance of preventive care

Relevance of the review for low-income countries

Additional information

Related literature

An overview summarising the findings of systematic reviews of the effectiveness of different interventions to improve professional practice: 

Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, Grilli R, Harvey E, Oxman AD, O'Brien M. 

Changing provider behavior: An overview of systematic reviews of interventions. Medical Care 2001; 39: Supplement 2, II-2 - II-45.

A systematic review assessing the effectiveness of various guideline dissemination and implementation strategies across different types of professional practice, including the delivery of preventive services:Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay C, Vale L et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004; 8: (6).


Systematic reviews evaluating the effectiveness of different strategies to change professional practice: Farmer AP, Légaré F, Turcot L, Grimshaw J, Harvey E, McGowan JL, Wolf F. Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD004398.


Jacobson Vann JC, Szilagyi P. Patient reminder and recall systems to improve immunization rates. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003941.


Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD000259.


A tool that provides a range of information, checklists, examples and tools based on current research on how to best design and evaluate quality improvement interventions: NorthStar - how to design and evaluate quality improvement interventions in healthcare.


This summary was prepared by

Cristian Herrera and Tomás Pantoja, School of Medicine, Pontificia Universidad Católica de Chile


Conflict of interest

None declared. For details, see:



This summary has been peer reviewed by: Martin Eccles, UK; Mike English, Kenya; George Pariyo, Uganda; Esperança Sevene , Alda do Rosário Elias Mariano and Julie Cliff, Mozambique.


This summary should be cited as

Herrera C, Pantoja T. Does prompting physicians improve performance in preventive care? A SUPPORT Summary of a systematic review. September 2009.