This section of Clinical Corner has been designed to spotlight recent BluePrint® newsletter articles which may be of particular interest to physicians and other professional providers.

• Cold and Sinus Antibiotic Management Program
• PCP recredentialing process now uses HEDIS-based criteria
• Practice management systems of successfully recredentialed PCPs

Regence BCBSO Continues the Cold and Sinus Antibiotic Management Program

Regence BCBSO Pharmacy Services announces the continuation of the Cold and Sinus Antibiotic Management Program for this year's cold and flu season. Our commitment to this program promotes both Centers for Disease Control (CDC) and state initiatives on judicious antibiotic use and the reduction of antibiotic resistance.

As part of this program, we are providing primary care physicians with over-the-counter (OTC) kits to give their patients when an antibiotic prescription may not be necessary. Each kit contains common OTC remedies for the symptoms of seasonal viruses and an educational brochure about treatment options for viral and bacterial infections. The program also includes a CDC OTC prescription pad for use with the patient kits.

We hope that the continuation of this year's program to more physicians and health care professionals will continue to strengthen both national and statewide efforts toward judicious antibiotic use. For more information about the program, please call Lynn Nishida, clinical pharmacist consultant, at (503) 226-8757.

PCP recredentialing process now uses HEDIS-based criteria

Regence HMO Oregon has improved its primary care physician (PCP) recredentialing process by applying patient selection criteria from the Health Plan Employer Data and Information Set (HEDIS). As part of every PCP's recredentialing, Regence HMO Oregon determines if the PCP maintained up-to-date records on whether selected patients received their recommended mammograms, Pap smears, or childhood immunizations.

Under the new criteria, which samples only patients assigned to the PCP for a specified length of time, the result is a much smaller sample of patients than in previous years. However, "since the criteria eliminate patients who have recently switched providers, plans, or geographical areas, we achieve more uniform comparisons within and across practices," says Dr. Allen Johnson, assistant vice president and medical director of quality management.

The revised criteria were applied to PCPs undergoing recredentialing on or after May 2002.

Survey finds variety of practice management systems among successfully recredentialed PCPs

An informal survey of Regence HMO Oregon PCPs scoring 100 percent in the new HEDIS-based recredentialing process indicates that while some practices have the luxury of an electronic data management system that allows for a virtually paperless office, others rely on manual data management-and still achieve successful results.

Gina Murray, radiology practice coordinator for internal medicine specialist Dr. Christopher Alftine, reports that Medford Medical Clinic has benefited from the installation of three commercially available data management systems. Prior to the installation of these new systems, "the doctors would either write notes by hand or use a dictaphone, and then we'd have to pay transcriptionists to type everything into our system," she says.

Now that the clinic has undergone its technological upgrade, data entry tends to be faster and more accurate for everyone concerned. With features such as appointment scheduling, appointment reminders, accounts receivable management, and even clinical decision support tools, these systems have greatly simplified recordkeeping.

However, with the technological boost comes a new level of accountability. "Now that we no longer use transcriptionists, the doctors are fully responsible for patient data accuracy," she says. "It's easier for nurses and schedulers to obtain and input information to accounts. This helps us be more efficient in scheduling and maintaining patients' care."

Attention to detail
Dr. Ralph Yates agrees that human effort is still an important part of the equation. "Every system can work well, but it's only as good as the data that's fed into it," says the Portland-based general practitioner, whose practice still uses paper for some of its data management. "The key people are our nurses," he says. "There's not a lot of turnover, and they're very stable. When we're seeing a high volume of individuals, it really makes a difference."

Norma McDaniel, clinic manager for Dr. Michelle Taube of Eugene, says that her system automatically generates a reminder that is mailed to patients due for an annual appointment. However, she says, the information that gets entered into the system depends entirely upon "how the ticket is filled out" by the physician.

Communication still matters
Despite procedural or technological differences in how they maintain patient information, Drs. Alftine, Taube, and Yates were among the PCPs who scored 100 percent when Regence HMO spot-checked a sample of patient records to determine whether certain preventive health measures (e.g., mammograms) were properly noted.

Murray attributes the success of her clinic to teamwork, not just technology. "At Medford Medical, we have open communication and an open-door policy. We can speak to doctors at any time, and it's great," she says.

Regardless of whether an office uses a manual or automated system to record preventive health measures, the final variable that determines whether the patient is likely to comply with those recommendations is the persuasiveness of the health-care professional. "The only thing that works is repeated reminding and encouragement," says Dr. Yates. "If patients are reluctant, I try to understand their fear, and then we discuss that fear. Later, when they finally comply, they invariably say that the office visits made a difference."