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
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.
Related Clinical Content
Most Read
