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Success and Failure in an Outpatient Trial

Donald W. Belcher, MD

Arch Intern Med. 1990;150(12):2533-2541.

Abstract
• Physicians endorse prevention but provide only low levels of screening, health counseling, and immunization. Between 1981 and 1986, a randomized controlled trial was conducted at the Seattle (Wash) Veterans Affairs Medical Center to assess the effectiveness of the following three methods of delivery of preventive services: (1) a physician-oriented model that includes education and motivation, a chart flowsheet listing recommended activities, and periodic feedback about performance; (2) a patient education model in which patients were mailed an informative brochure advising them to ask physicians for preventive services as depicted in a patient-held pocket guide; and (3) a health promotion clinic that patients were invited to attend. A control group received their usual care. A total of 1224 male outpatients were enrolled in the trial. Baseline prevention rates for 12 age-specific prevention activities were below 25%. Neither the control group rates during the 5-year trial nor the rates for the two educational models, either singly or as a combined intervention, changed. Only the health promotion clinic model was effective, tripling prevention rates in its first year and sustaining these levels for all 5 years. It is difficult to change the clinic roles of experienced physicians and their long-term patients in a specialized multiclinic setting. Providing a separate health promotion clinic option is popular with patients, bypasses gatekeeper barriers, is reasonable in cost, and warrants wider application.

(Arch Intern Med. 1990;150:2533-2541)

Author Affiliations
From the Division of General Internal Medicine, University of Washington, Seattle, and Veterans Affairs Medical Center, Seattle.

Footnotes
Accepted for publication June 21, 1990.

Presented in part at the national meeting of the Society of General Internal Medicine, Washington, DC, June 4,1988.

Reprints not available.

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