Gastroenterology

Gastroenterology

Volume 140, Issue 4, April 2011, Pages 1166-1173.e3
Gastroenterology

Clinical—Alimentary Tract
An Alerting System Improves Adherence to Follow-up Recommendations From Colonoscopy Examinations

https://doi.org/10.1053/j.gastro.2011.01.003Get rights and content

Background & Aims

Systems are available to ensure that results of tests are communicated to patients. However, lack of adherence to recommended follow-up evaluation increases risk for adverse health outcomes and medical or legal issues. We tested the effectiveness of a novel follow-up system for patients due for surveillance colonoscopy examinations.

Methods

Electronic medical records from colonoscopies performed 5 years prior were reviewed to identify individuals due for a repeat surveillance colonoscopy examination. Patients were assigned to groups that received the standard of care or a newly developed follow-up system that included a letter to the primary care provider, 2 letters to the patient, and a telephone call to patients who had not yet scheduled an examination by the procedure due date. The primary end point was the percentage of patients who scheduled or completed the colonoscopy examination within 6 months of the due date. Secondary end points included detection rate for adenomas, sex- and ethnicity-specific follow-up rates, and patient satisfaction.

Results

Of 2609 patient records reviewed, 830 (31.8%) were found to be due for a surveillance colonoscopy examination in the study period. At the conclusion of the study, 241 (44.7%) patients in the intervention arm had procedures scheduled or completed, compared with 66 (22.6%) in the control group (P < .0001). The follow-up system appeared particularly effective among non-white patients; patients reported general satisfaction with the reminder program.

Conclusions

A simple protocol of letters and a telephone call to patients who are due for colonoscopy examinations significantly improved adherence to endoscopic follow-up recommendations. This work provides justification for the creation of reminder systems to improve patient adherence to medical recommendations.

Section snippets

Development of Principles for an Automated Follow-up Reminder System

Interviews and meetings with primary care and gastroenterology physicians suggested overlapping but not identical requirements for a colonoscopy follow-up management system that included the following 7 principles: (1) both the specialist and primary care physician (PCP) should be able to place and alter the colonoscopy referral; (2) PCPs should be notified when the follow-up procedure is due, and before the patient is contacted so that, when appropriate, the order can be modified or canceled;

Results

Of 2609 patients identified from August 1, 2004, to February 28, 2005, there were 830 (31.8%) eligible for randomization. The most common reasons for lack of eligibility were that patients were not yet due for follow-up evaluation (32.5%) or had interval colonoscopies performed early for diagnostic purposes (18.7%) (Figure 2).

Of the 830 patients, 539 were randomized to the intervention arm and the remaining 291 were followed up without intervention. Demographics and index colonoscopic factors

Discussion

In this study we created and tested an EMR-based system that reminds patients and providers when follow-up examinations, in this case colonoscopies, are due and provides documentation in the medical record of this communication. Our study is notable for several important results. First, the low-cost intervention almost doubled the rate of recommended examinations during the time period of the study. Second, the intervention was even more effective in minority populations who typically receive

Acknowledgments

The authors greatly appreciate the assistance of Eileen Joyce and Sara O'Conner in the Division of Gastroenterology, Beth Israel Deaconess Medical Center, and Kenneth Sands, MD, Department of Medicine, Beth Israel Deaconess Medical Center.

Clinical Trials Registration: clinicaltrials.gov #NCT01172080.

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    This article has an accompanying continuing medical education activity on page e13. Learning Objective: Upon completion of this CME module successful learners will be able to explain issues in follow-up colonoscopy adherence and identify potential solutions to improve follow up and reduce risk.

    Conflicts of interest The authors disclose no conflicts.

    Funding Supported by Controlled Risk Insurance Company (CRICO)-Risk Management Foundation. The study sponsor had no role in study design, data collection, analysis, or interpretation.

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