Predicting Adherence to Colonoscopy or Flexible Sigmoidoscopy on the Basis of Physician Appointment–Keeping Behavior

Predicting Adherence to Colonoscopy or Flexible Sigmoidoscopy on the Basis of Physician Appointment–Keeping Behavior

Barbara J. Turner, MD, MSEd;
Mark Weiner, MD;
Chuya Yang, MS; and
Thomas TenHave, PhD

From University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Abstract

Background: Poor patient attendance to scheduled flexible sigmoidoscopy or colonoscopy may contribute to deficient colorectal cancer screening.

Objective: To examine the association of physician appointment-keeping behavior with attendance to scheduled endoscopic studies of the colon.

Design: Retrospective cohort.

Setting: 23 sites performing endoscopic procedures in a health care system.

Patients: 11 803 patients scheduled for a first colon study with 3 or more scheduled physician visits from June 1999 through November 2001.

Measurement: 2 outcomes from health system computerized records: 1) attendance at the first scheduled colon study and 2) among nonattendees, attendance at the study rescheduled within 6 months. Physician visit adherence was defined as the proportion of physician visits kept, grouped by quartile. Adjusted associations were examined in conditional logistic regression.

Results: Of 11 803 patients, 62% attended the first colon study. Of the 4496 nonattendees, 2739 (61%) rescheduled and, of these, 64% kept that appointment. Compared with the highest quartile of physician visit adherence (>85%), the adjusted odds ratio of attending the first colon study decreased as physician visit adherence decreased: Adjusted odds ratios were 0.94 (95% CI, 0.89 to 1.00) for 76% to 85% adherence, 0.87 (CI, 0.81 to 0.92) for 66% to 75% adherence, and 0.79 (CI, 0.73 to 0.85) for adherence of 65% or less. Among nonattendees who rescheduled, the lowest quartile of physician visit adherence (≤ 65%) was the only statistically significant predictor of attending the rescheduled study (adjusted odds ratio, 0.87 [CI, 0.78 to 0.98]).

Limitations: The adherence measure applies only to patients with at least 3 scheduled visits. Persons having a colon study outside of the system could have been misclassified.

Conclusion: Physician appointment-keeping behavior predicted attendance to colorectal endoscopic studies in this cohort and may help identify persons who need interventions to promote adherence.

Article and Author Information

Presented at the 25th Annual Meeting of the Society of General Internal Medicine, Atlanta, Georgia, 2–4 May 2002.
Requests for Single Reprints: Barbara J. Turner, MD, MSEd, University of Pennsylvania, 1123 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; e-mail, bturner{at}mail.med.upenn.edu.
Potential Financial Conflicts of Interest: None disclosed.
Current Author Addresses: Dr. Turner: University of Pennsylvania, 1123 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.
Drs. Weiner and TenHave: University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104.
Ms. Yang: University of Pennsylvania, 1135 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.
Author Contributions: Conception and design: B.J. Turner, M. Weiner.
Analysis and interpretation of the data: B.J. Turner, M. Weiner, T. TenHave.
Drafting of the article: B.J. Turner.
Critical revision of the article for important intellectual content: B.J. Turner, M. Weiner, T. TenHave.
Final approval of the article: B.J. Turner, M. Weiner, T. TenHave, C. Yang.
Provision of study materials or patients: M. Weiner.
Statistical expertise: T. TenHave.
Administrative, technical, or logistic support: M. Weiner,
Collection and assembly of data: M. Weiner, C. Yang.