WHAT ARE RECALL AND REMINDER SYSTEMS?
Provided by ACEDGP, Chronic Disease Resource Manual, March 2008

• The term register usually refers to a database
• A recall/reminder system refers to a process that actively identifies and systematically recalls patients for visits that are due
• Recall - usually used for abnormal results where it is essential or highly recommended that the patient return to the practice
• Reminders - usually used for preventative care
• Registers/recalls can be local i.e. GP, State i.e. Pap Register or National i.e. ACIR
• Local recalls are more effective, especially if they come from the patient’s GP

• Chronic Disease Management: Asthma, Diabetes, Cervical Screening, Mental Health
• Specific Morbidities: CVD, skin cancer, etc
• Risk Factors: cholesterol, blood sugar, BP, etc
• Prevention: annual checkups, mammography, immunisation etc
• Enhanced Primary Care: care plans and reviews
• Home Medication Review
• Administrative Functions: collect x-rays, etc

• Only patients who normally attend the practice should receive recall notices
• Seek patient’s consent before placing them on a recall register
• Recall notification should only be for a specific aspect of continuing care and/or specific preventative care

• It is appropriate to monitor patients with established diseases by recall
• There is a clear obligation on the doctor to recall patients who have failed to follow-up abnormal   tests

• The recall of patients at appropriate intervals for preventative care is recommended
• The RACGP accepts a protocol of preventative care recalls. Such a schedule would be regarded as constituting a minimal standard of preventative care, subject to variation at the discretion of the doctor

PATIENT CONSENT  

• Raise the issue of prevention in the consultation
• Outline to the patient the reason why you think CDM is important
• Link the preventative activity with the patient’s presenting complaint - this will increase the relevance and acceptability of the activity
• Explain both the nature and extent of your’s and your patient’s responsibility
• Obtain consent, which should include both the method and frequency of contact
• Back up what you are saying with patient information and literature; give the Practice Information Sheet to the patient to advise them of the reminder system and of the practice’s policy to enrol patients in the system unless they advise otherwise
• Example: “Our practice will send out a reminder letter to you (or we will phone you) to attend a 3 monthly blood pressure check”(CCDGP Manual 2007)

INFORMED CONSENT

A patient has every right to refuse your advice – but the burden is on you to ensure that refusal is informed. This also applies to patients who refuse your offer of being entered into a computerised reminder system. A patient refusal should be documented in their file.

Not only should you offer to remind the patient, you should also adequately inform them why they should consult a doctor when they receive the reminder. You should inform them about the length of the recall interval and what will be done when they are recalled. 

For example, rather than saying “Your Pap Smear is clear, please come in for another one in two years time”, it is better to say, “Your Pap Smear is clear. There is good evidence that screening for cervical cancer is most effective if repeated every two years, even when the last smear was 100% clear”. In the latter case, if the patient does not return in two years, she does so (consciously or unconsciously) at her own risk, in the knowledge that she is departing from an optimal screening program.

You should also inform the patient that the reminder system is an aid for follow-up, but like any system, can be prone to error. This may involve human error within the practice, computer failure or even mistakes occurring with Australia Post. Patients should be encouraged to make their own note of when they are due for recall, in case there is a failure in the practice’s reminder system.

• Record Clinical Data
• Identify Eligible patients
• Set-up Recall Database
• Search Recall Database
• Generate Reminder Letters
• Maintain Recall Database
• Maintain Clinical Data

Printed from http://www.scdgp.org.au/page/Programs/Chronic_Disease_Management_QI/Recall_and_Reminder_Systems_/ © Sunshine Coast Division of General Practice (SCDGP), Australia