TABLE 3—

2003–2010 Public Health Detailing Campaigns: Self-Reported Changes in Clinical Practice: New York City Department of Health and Mental Hygiene (DOHMH)

Campaign	Campaign Assessment Questions and Responses	Baseline (Initial), %	Follow-Up, %	P
Influenza and Pneumococcal Vaccination 2003	Who do you offer flu vaccines to?
	To patients in all groups under the CDC recommendation	94	99	.02
	Do you use an office system to prompt you to offer flu vaccine to patients at the time of their visit?
	Use office system as reminder to offer flu vaccine	54	67	.04
Colon Cancer Screening 2004	What primary screening method do you recommend for colon cancer?
	Colonoscopy as primary method	26	42	.01
	What is the clinic’s policy/practice regarding colon cancer screening?
	Has an office system in place to promote colon cancer screening	52	62	.01
Smoking Cessation 2004	How often do you assess smoking status?
	Assess smoking status at every visit	42	a	…
Asthma 2004	For patients with asthma, do you indicate a level of severity on their chart?
	Yes	68	a	…
	How do you usually assess severity?
	History, spirometry, or peak flow at time of visit	72	a	…
	Do you usually prescribe controller medications for patients with persistent asthma?
	Yes	96	a	…
	What type of controller medication do you most often prescribe?
	Inhaled corticosteroids	85	a	…
	Do you routinely provide patients with a written self-management plan?
	Yes/sometimes	50	a	…
Diabetes 2005	What are your specific clinical management goals for hemoglobin A1c?
	At least every 6 months	66	92	<.01
	A1c target level ≤ 7%	61	83	<.01
	What tools/systems do you use to track patients who are meeting their goals?
	Checkbook (clinical tracking tool developed by the DOHMH)	28	43	<.01
Contraception 2005	How is sexual history documented?
	Has an office system to document sexual history	15	21	.17
	Do you ever prescribe emergency contraception in advance?
	Advance prescribing of emergency contraception	7	17	.01
Hypertension 2005	What lifestyle changes do you routinely discuss with your patients with high blood pressure?
	Discusses lifestyle change with patients re: weight loss	68	80	.1
	Discusses lifestyle change with patients re: physical activity	88	94	.1
	For which patients with hypertension do you recommend home blood pressure monitoring?
	Recommends for self-motivated patients	23	27	.1
Depression Screening 2006	What type of patients do you generally screen for depression?
	Screens all patients as part of routine screening	41	40	.1
	Do you use a standard instrument to screen for depression?
	Uses PHQ-2 and/or PHQ-9 to screen for depression	13	40	.01
HIV Testing 2006	Who do you routinely offer HIV testing to within your practice?
	Offers routine testing to all patients (18–64)	39	44	.45
	What type of HIV testing do you perform in your office, if any?
	Uses rapid testing	13	20	.19
Cholesterol 2006	For patients with high cholesterol, diabetes, and/or atherosclerotic disease, what interventions do you routinely recommend for their cholesterol?
	Recommends general diet change	64	76	.05
	Recommends increased physical activity	52	73	.01
	Recommends statins	54	51	.01
	For patients with diabetes and no other complication, what is your LDL goal for treatment?
	LDL treatment goals of < 100 mg/dL	62	73	.1
	When you prescribe medications, do you regularly provide patients with supporting materials or tools to address adherence? If yes, what are some examples?
	Provides educational materials on medication(s) and/or medication log	35	59	<.01
Alcohol Screening and Brief Intervention 2007	What types of patients do you generally assess for problem drinking?
	Screens all patients for problem drinking	67	76	.1
	Do you use a standard screening tool to assess problem drinking?
	Assesses using the CAGE-AID	22	42	.01
Electronic Health Records 2007	Are you considering adopting an electronic health record system for your practice?
	Yes	41	34	.09
Identifying & Reporting Child Abuse & Neglect 2007	Have you reported a case of child abuse and neglect within the last 2 y?
	Yes	40	45	.43
	How do/would you report suspected child abuse and neglect?
	Call the State Central Register	75	98	<.01
	Have you had any training on identifying child abuse and neglect other than the New York State training requirement?
	Yes	39	40	.79
Adult Obesity 2008	How do you assess your patients for obesity?
	Assesses using BMI and weight history	25	47	.01
	In the past week, have you used nutritional visuals or props when speaking with your patients about obesity?
	Uses nutritional visuals or props	25	91	.01
	In the past week, have you done formal goal setting with your patients to address obesity?
	Uses formal goal setting with patients	78	96	.01
Medical Reserve Corps 2008	Have you heard of New York City Medical Reserve Corps?
	Yes	57	100	<.01
	Are you currently a New York City Medical Reserve Corps volunteer?
	Yes	1	18	<.01
	Would you like become a New York City Medical Reserve Corps volunteer?
	Yes	44	51	.31
Colon Cancer Screening 2008	What test do you usually recommend for colon cancer screening?
	Colonoscopy	93	82	.01
	When you refer patients for screening, what referral form do you use?
	DERS form	9	16	.09
Intimate Partner Violence 2009	Whom do you screen for intimate partner violence?
	All patients	39	67	<.01
	How often do you screen for intimate partner violence?
	At every visit	27	28	.75
	Routine inquiry and dialogue	14	42	<.01
	What do you do when a patient discloses intimate partner violence?
	Refer to domestic violence hotline	13	33	<.01
	Schedule a follow-up appointment	9	20	<.01
Breastfeeding 2009	What infant feeding method do you recommend during prenatal visits?
	Exclusive breastfeeding	51	50	.96
	For breastfeeding babies, how soon after birth do you schedule newborn visit?
	3–5 d after birth	32	33	.76
	What is your policy regarding hospital staff giving formula during admission and/or at discharge in the form of samples?
	Does not allow formula during hospital stay or in discharge packs	20	26	.13
Obesity in Children 2009	How do you currently assess for overweight or obesity in children aged 2–18?
	BMI percentile-for-age	77	88	<.01
	How often do you assess for overweight or obesity in children aged 2–18 y?
	At every visit	59	73	<.01
	In the past month, whom have you counseled for healthy eating and physical activity?
	All patients and their parent/caregiver	67	85	<.01
Medication Adherence 2010	How often do you reconcile patient’s medication lists?
	At every visit	86	94	<.01
	What prescribing practices do you use to increase patients’ adherence to their medications?
	Prescribe once-daily formulations, if possible	43	58	<.01
	Prescribe combination pills to decrease number of medications	26	43	<.01
	Prescribe generic or lower-cost branded drug	52	79	<.01
	Prescribe longer-lasting supplies	29	60	<.01
	Adjust dosages	52	66	.04
	Depends on Insurance	36	52	<.01
	How frequently do you write prescriptions of greater than a 30-d supply for patients on long-term maintenance medications?
	Often	36	41	.02

Note. BMI = body mass index (defined as weight in kilograms divided by the square of height in meters); CAGE-AID = CAGE Questionnaire Adapted to Include Drugs; CDC = Centers for Disease Control and Prevention; DERS = Direct Endoscopic Referral System; LDL = low-density lipoprotein; PHQ = Patient Health Questionnaire.

^aNo data available.