The impact of clinical reminders on prenatal care.

BACKGROUND AND OBJECTIVES This study assessed the effect of automated prenatal care reminders on adherence to standards of prenatal care at two family medicine teaching clinics. METHODS This was a reversal-design prospective study using medical records of prenatal patients during baseline, intervention, and post-intervention periods. RESULTS A total of 9.5% of patients received all guideline-recommended care at baseline compared to 55.7% in the intervention period, decreasing to 17.1% after the intervention. The most commonly missed services were offering first trimester aneuploidy screening and genetic screening, HIV screening, considering the need for repeat third trimester gonorrhea and chlamydia (GC/Chl) screening, and influenza vaccination. The clinical reminders significantly improved the number of patients offered HIV testing, given influenza vaccination, and tested or considered for repeat GC/Chl. Improvement in first trimester aneuploidy screening approached but did not meet statistical significance due to lower numbers of patients qualifying for this service. HIV testing and repeat GC/Chl screening significantly decreased in the post-intervention period, and compliance with most other standards trended downward as well. CONCLUSIONS Adherence to prenatal care standards by resident and faculty family medicine providers at baseline was less than optimal. Clinical reminders significantly improved overall adherence to prenatal standards and improved compliance with the most commonly missed standards. When the reminders were no longer active, compliance regressed toward baseline levels. These results support the use of prenatal care reminders as an effective way to help family physicians provide and document comprehensive prenatal care.