Predictors of adherence to post-polypectomy surveillance colonoscopy
Calderwood, Audrey Hong
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BACKGROUND: Effective colorectal cancer prevention programs should ensure that patients with adenomas receive timely surveillance colonoscopy consistent with guidelines. The aim of our study was to identify patient-, provider-, and system-level predictors of adherence with surveillance colonoscopy in an ethnically diverse safety-net population. METHODS: We performed a retrospective analysis of average-risk patients age 50-75 with adenomas diagnosed at screening colonoscopy at Boston Medical Center and its affiliated community health centers from 1/1/2005 to 12/31/2007. The primary outcome was on-time follow-up defined as attendance at surveillance colonoscopy within 5.5 years of the screening colonoscopy. We compared frequencies of on-time follow-up and performed multivariable analysis, including ethnicity/language and any variable with P value <0.20 in unadjusted analysis. RESULTS: We identified 891 patients, of which 38% were English-speaking Non-Hispanic blacks, 24% Non-Hispanic white, and 10% Spanish-speaking Hispanics. Overall, 38.2% attended on-time surveillance colonoscopy. In unadjusted analyses, having ≥3 PCP visits in year 3-5 after baseline colonoscopy (OR 3.6 [2.6-5.1]), having “adenoma” on the electronic medical record problem list (OR 2.2 [1.6-2.9]), age (OR 0.98 [0.96-1.0]), and Charlson Index ≥1 (OR 1.3 [1.0-1.8]) were positively associated with adherence. In multivariate analysis, having “adenoma” on the problem list remained significant (adjusted OR (aOR) 1.8 [1.3-2.5]). Significant interactions were observed for ethnicity/language and PCP visits (P=0.008). CONCLUSION: A substantial proportion of adenoma-bearing patients fail to attend surveillance colonoscopy even in a safety net setting. Adding “adenomas” to the EMR problem list improved attendance, suggesting that system-level interventions may increase adherence to surveillance colonoscopy.
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