Effects of office system and educational interventions in increasing the delivery of preventive health services: A meta-analysis

Objectives: To examine quantitative effect of office system and educational intervention in selected preventive health services (PHS) in primary care practices and whether effectiveness differed by study and intervention characteristics. Methods: Fifty studies that conducted officebased interventions for improving PHS were retrieved from various computerized databases. Selected studies were based on the following criteria: (1) published since 1990, (2) contain results on the practices of primary care providers allowing calculation of at least one effect size, (3) data related to one or more of the following classifications of preventive health services: screening, lifestyle counseling and adult immunization, and (4) use office system tools or educational components. Results: There were small to medium effects for office system and educational interventions focusing on life style counseling (effect sizes range from 0.45 to 0.64, P<0.0001) and adult immunizations (effect sizes range from 0.26 to 0.50, P<0.0001). However, interventions produced smaller effects for screening tests (effect sizes range from 0.07 to 0.22). Greater success was found for studies lasting 7 to 12 months and using chart audit measurement regardless of the type of preventive health service. With the exception of screening tests, delivery rates improved most when the subjects were the targets of a combination of three or more interventions. Interventions targeting patients were more successful than those targeting providers for screening tests and lifestyle counseling. Conclusions: The effectiveness of office system and educational interventions for improving delivery rates is well-supported, especially for lifestyle counseling and adult immunizations.