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December 13, 2000

Effectiveness of Computerized Reminders in Ambulatory Care

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(22):2872-2873. doi:10.1001/jama.284.22.2869

To the Editor: In their study of computerized reminders for medical residents providing routine ambulatory care, Dr Demakis and colleagues1 note that the initial effectiveness of the reminders declined over time. In addition to the explanations provided by the authors, this finding may have been caused by time-associated changes in the patients receiving reminders vs usual care. The initial similarities in the treatment groups at baseline may not persist over time, particularly if an effective intervention promotes a higher rate of procedures among the reminder group as compared with those receiving usual care. Furthermore, subjects who remain eligible for recommended services despite their previous visits may represent an increasingly "resistant" group of patients who are less interested or less appropriate candidates for the service. An apparent decline in effectiveness of reminders might be caused by the increasing proportion of such patients.