In this review we examine the effectiveness of computer-generated paper reminders to health care professionals and address the following primary hypotheses:
1. Computer-generated paper reminders are effective compared with no intervention.
2. Computer-generated paper reminders combined with other interventions are effective compared to the other interventions alone (without reminders).
In the original protocol, it was also planned to examine whether computer-generated paper reminders were more effective than other interventions, whether computer-generated paper reminders combined with other interventions were more effective than no intervention, and whether computer-generated paper reminders combined with other interventions were more effective compared with manual reminders alone. As the primary objective of this review is to evaluate the effectiveness of computer-generated paper reminders specifically, we decided to eliminate these questions. They do not permit to evaluate the specific effect of reminder. Such studies will be reported in the excluded studies, as ineligible comparison or inappropriate control.
We will also address the following secondary hypotheses:
Content of reminder3. Reminders that include some individual patient-specific information are more effective than generic reminders.
4. Reminders that indicate a response should be recorded or given are more effective than reminders that do not require a response.
5. Reminders that offer explicit advice on patient management are more effective than reminders that offer general information only, for example about prevalence of a disease.
6. Reminders that include an explanation of their content or advice are more effective than reminders that do not include this.
7. Reminders that are explicitly from or justified by reference to an influential source are more effective than reminders from another source. An influential source is a person or body likely to be perceived as credible by the target clinician.
8. Reminders available at point of care (i.e. at patient's visit) are more effective than reminders available at another time (e.g. after patient's visit).
Behaviour targeted by intervention9. Reminders will vary in effectiveness systematically according to the targeted activity (e.g. test ordering, prescription).
In the original protocol, it was also planned to examine the influence of the development of the reminder (reminders developed with the involvement of target clinicians) and the delivery of reminder (reminders delivered by or with the knowledge of the target clinician’s colleagues or patients). As this type of information was rarely available in the articles, we decided to exclude them from the secondary analyses.