Nurse-initiated health promotion prompting system in an internal medicine residents' clinic

Although cure of many diseases depends on early detection, screening schemes have been difficult to implement in busy clinic environments. We describe the testing of a nurse-initiated prompting system for six health promotion and disease prevention procedures in an internal medicine residents' clinic at a university-affiliated community program. Maneuvers investigated were breast examination, pelvic examination and Pap smear, rectal examination in men, mammogram, stool guaiac test, and blood glucose determination. A nurse reviewed the charts and used a list in the front of each chart to prompt residents in the experimental group. Residents in the control group were not prompted. A significant improvement (P less than .05) in performance was seen in the prompted group. Performance of rectal examination and mammograms improved most, increasing from 41% to 93% and 18% to 64%, respectively. There were no significant changes in the control group. This simple nurse-initiated prompting system improved the performance of health promotion and disease prevention maneuvers.