Original Article

Improving Preventive Care for Women through a Provider Reminder Tool

Authors: Suellen A. Romero de Mello Sa, MD, Lazarus K. Mramba, PhD, Maryam Sattari, MD, MS


Objective: To determine the association of utilization of health maintenance tables (HMTs) as a provider reminder tool within the electronic medical record with the completion of women’s preventive health services.

Methods: Guidelines from the US Preventive Services Task Force and the Advisory Committee on Immunization Practices were used to create the HMT. The study sample consisted of female patients between 18 and 74 years of age who visited the University of Florida Internal Medicine Clinic at Medical Plaza between February 15, 2016 and June 24, 2016. We determined whether a reminder system was used for each visit and whether the following preventive health services were up to date: breast cancer screening, cervical cancer screening, and human papillomavirus vaccination. χ2 tests of independence were performed to compare the number of up-to-date preventive measures associated with each provider reminder type.

Results: We divided the visits into four groups based on the type of provider reminder used: the HMT, the computer-generated reminder .HM, simple annotation, and no reminder. Compared with .HM, no reminder, and all non-HMT, HMT utilization had a statistically significant positive association with the completion of breast and cervical cancer screening and human papillomavirus vaccination. The difference between the HMT and simple annotation groups did not achieve statistical difference, however.

Conclusions: Despite well-established, evidence-based guidelines for screening tests and immunizations effective in reducing cancer-related morbidity and mortality, significant gaps in routine preventive care remain. The HMT may be a provider-friendly and cost-effective reminder tool to enhance the preventive health care of women.
Posted in: Obstetrics and Gynecology44

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. American Cancer Society. Breast cancer facts & figures 2017-2018. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-andstatistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures2017-2018.pdf. Accessed January 10, 2019. 2. Nelson HD, Tyne K, Naik A, et al. Screening for breast cancer. Systematic evidence review update for the US Preventive Services Task Force. https://www.ncbi.nlm.nih.gov/books/NBK36392. Accessed January 10, 2019. 3. Lester WT, Ashburner JM, Grant RW, et al. Mammography FastTrack: an intervention to facilitate reminders for breast cancer screening across a heterogeneous multi-clinic primary care network. J Am Med Inform Assoc 2009;16:187–195. 4. Vernon SW, McQueen A, Tiro JA, del Junco DJ. Interventions to promote repeat breast cancer screening with mammography: a systematic review and meta-analysis. J Natl Cancer Inst 2010;102:1023–1039. 5. Society of Gynecologic Oncologists Education Resource Panel Writing Group, Collins Y, Einstein MH, et al. Cervical cancer prevention in the era of prophylactic vaccines: a preview for gynecologic oncologists. Gynecologic Oncology 2006;102:552–562. 6. Petrosky E, Bocchini JAJr, Hariri S, et al. Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2015;64:300–304. 7. Centers for Disease Control and Prevention, National Center for Health Statistics. Health, United States, 2017: with special feature on mortality. https://www.cdc.gov/nchs/data/hus/hus17.pdf. Assessed January 10, 2019. 8. Walker TY, Elam-Evans LD, Yankey D, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 Years—United States, 2017. MMWR Morb Mortal Wkly Rep 2018;67:909–917. 9. Levy BT, Nordin T, Sinift S, et al. Why hasn’t this patient been screened for colon cancer? An Iowa Research Network study. J Am Board Fam Med 2007;20:458–468. 10. National Institutes of Health, National Cancer Institute. President’s Cancer Panel annual report 2012–2013: accelerating HPV vaccine uptake: urgency to action to prevent cancer. https://deainfo.nci.nih.gov/Advisory/pcp/annualReports/HPV/index.htm. Accessed January 10, 2019. 11. Centers for Disease Control and Prevention. Human papillomavirus vaccination coverage among adolescent girls, 2007–2012, and postlicensure vaccine safety monitoring, 2006-2013—United States. MMWR Morb Mortal Wkly Rep 2013;26;62:591–595. 12. Gilkey MB, Moss JL, McRee A-L, et al. Do correlates of HPV vaccine initiation differ between adolescent boys and girls? Vaccine 2012;30:5928–5934. 13. McPhee SJ, Bird JA. Implementation of cancer prevention guidelines in clinical practice. J Gen Intern Med 1990;5(5 suppl):Sl16–S122. 14. Dexheimer JW, Talbot TR, Sanders DL, et al. Prompting clinicians about preventive care measures: a systematic review of randomized controlled trials. J Am Med Inform Assoc 2008;15:311–320. 15. Schellhase KG, Koepsell TD, Norris TE. Providers’ reactions to an automated health maintenance reminder system incorporated into the patient’s electronic medical record. J Am Board Fam Pract 2003;16:312–317. 16. Burack RC, Gimotty PA, Simon M, et al. The effect of adding Pap smear information to a mammography reminder system in an HMO: results of randomized controlled trial. Prev Med 2003;36:547–554. 17. Shojania KG, Jennings A, Mayhew A, et al. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database System Rev 2009;2009:CD001096. 18. Romero de Mello Sa SA, Mramba LK, Sattari M. Health maintenance tables and completion of cervical cancer screening: a cross-sectional observational study. Frontiers in Women’s Health 2018;3:1–6. 19. Luu SW, Sattari M. Improving influenza vaccination rate with health maintenance tables. J Gen Intern Med 2016;31(suppl 2):271–272. 20. US Preventive Services Task Force. Final recommendation statement. Breast cancer: screening. https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/breast-cancer-screening. Accessed January 10, 2019. 21. Stewart Massad L, Einstein MH, Huh WK, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2013;17(5 suppl 1):S1–S27. 22. US Preventive Services Task Force. Final recommendation statement. Cervical cancer: screening. https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/cervical-cancerscreening. Accessed January 10, 2019. 23. Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination—updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016;65:1405–1408. 24. Schmittdiel J, McMenamin SB, Halpin HA, et al. The use of patient and physician reminders for preventive services: results from a National Study of Physician Organizations. Prev Med 2004;39:1000–1006. 25. Litzelman DK, Dittus RS, Miller ME, et al. Requiring physicians to respond to computerized reminders improves their compliance with preventive care protocols. J Gen Intern Med 1993;8:311–317. 26. Morgan MM, Goodson J, Barnett GO. Long-term changes in compliance with clinical guidelines through computer-based reminders. Proc AMIA Symp 1998;493–497. 27. Jacob V, Chattopadhyay SK, Hopkins DP, et al. Increasing coverage of appropriate vaccinations: a community guide systematic economic review. Am J Prev Med 2016;50:797–808.