Effect of a Mailed Brochure on Appointment-Keeping for Screening Colonoscopy

A Randomized Trial

  1. Thomas D. Denberg, MD, PhD;
  2. John M. Coombes, MD;
  3. Tim E. Byers, MD, MPH;
  4. Alfred C. Marcus, PhD;
  5. Lawrence E. Feinberg, MD;
  6. John F. Steiner, MD, MPH; and
  7. Dennis J. Ahnen, MD
  1. From University of Colorado at Denver and Health Sciences Center, Denver, Colorado.

    Abstract

    Background: Even when primary care physicians have face-to-face discussions with patients before referring them for screening colonoscopy, patient nonadherence can be substantial. Often, primary care physicians lack sufficient time to educate patients and address their potential misconceptions and fears about this procedure.

    Objective: To test whether an informational brochure sent to patients' home addresses after referral for screening colonoscopy would increase patient completion of the procedure.

    Design: Randomized, controlled trial.

    Setting: 2 general internal medicine practices affiliated with the University of Colorado Health Sciences Center.

    Patients: 781 consecutive patients 50 years of age or older referred by their primary care physicians for screening colonoscopy.

    Intervention: Patients were randomly assigned to receive usual care (control group) versus usual care plus an informational brochure (intervention group). The brochure was mailed within 10 days of referral for screening colonoscopy; it mentioned the name of the patient's primary care physician and encouraged patients to schedule a procedure. It also described colorectal cancer and polyps and the similar lifetime risks for colorectal cancer for men and women, colonoscopy and risk for perforation, the nature of bowel preparation for the procedure, and alternative screening tests.

    Measurements: Rates of adherence to screening colonoscopy in the 2 study groups.

    Results: The overall adherence rate was 11.7 percentage points (95% CI, 5.1 to 18.4 percentage points) greater in the intervention group than in the control group (70.7% vs. 59.0%). Older patients were more adherent than younger patients. Patients with low-income insurance plans, such as Medicaid, were less adherent despite being sent a brochure.

    Limitations: The small number of clinical practices and minority patients may limit generalizability. In addition, it was not possible to determine the degree to which adherence was influenced by a reminder to schedule a procedure versus detailed information about colonoscopy.

    Conclusions: An inexpensive mailed brochure is an effective way to increase patient adherence to primary care physician referral for screening colonoscopy.

    Article and Author Information

    • Acknowledgments: The authors thank Brenda L. Beaty, MPH, for statistical analysis and Trisha V. Melhado, BS, for data collection.

    • Grant Support: In part by the American Cancer Society MRSG-06-081-01-CPPB; Principal Investigator, Dr. Denberg.

    • Potential Financial Conflicts of Interest: None disclosed.

    • Requests for Single Reprints: Thomas Denberg, MD, PhD, 4200 E. 9th Avenue, B-180, Division of General Internal Medicine, University of Colorado at Denver and Health Sciences Center, Denver, CO 80262; e-mail, tom.denberg{at}uchsc.edu.

    • Current Author Addresses: Dr. Denberg: 4200 East 9th Avenue, B-180, Division of General Internal Medicine, University of Colorado at Denver and Health Sciences Center, Denver, CO 80262.

    • Dr. Coombes: 4200 East 9th Avenue, B-158, Division of Gastroenterology and Hepatology, University of Colorado at Denver and Health Sciences Center, Denver, CO 80262.

    • Dr. Byers: Campus Box F-519, Department of Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Aurora, CO 80045.

    • Dr. Marcus: Campus Box B-119, Department of Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Denver, CO 80262.

    • Dr. Feinberg: Campus Box B-212, 360 South Garfield Street, Suite 520, Division of General Internal Medicine, University of Colorado at Denver and Health Sciences Center, Denver, CO 80209.

    • Dr. Steiner: Campus Box F-443, Colorado Health Outcomes Program, University of Colorado at Denver and Health Sciences Center, Aurora, CO 80045.

    • Dr. Ahnen: Denver Veterans Affairs Medical Center, Department of Gastroenterology and Hepatology, 1055 Clermont Street, Denver, CO 80220.

    • Author Contributions: Conception and design: T.D. Denberg, J.M. Coombes, D.J. Ahnen.

    • Analysis and interpretation of the data: T.D. Denberg, J.M. Coombes, T.E. Byers, A.C. Marcus, D.J. Ahnen.

    • Drafting of the article: T.D. Denberg, J.M. Coombes, A.C. Marcus.

    • Critical revision of the article for important intellectual content: T.D. Denberg, J.M. Coombes, T.E. Byers, J.F. Steiner, L.E. Feinberg, D.J. Ahnen.

    • Final approval of the article: T.D. Denberg, T.E. Byers, A.C. Marcus, L.E. Feinberg, D.J. Ahnen.

    • Provision of study materials or patients: L.E. Feinberg.

    • Obtaining of funding: T.D. Denberg.

    • Administrative, technical, or logistic support: T.D. Denberg.

    • Collection and assembly of data: J.M. Coombes.

    Responses to this article

    • Distribution of Patient Brochures: A pragmatic solution to resolving the information gap
      • Pascal Vignally and
      • Stephanie Gentile, Nancy Binkin, Jean Charles Grimaud
      Ann Intern Med published online October 26, 2009
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    1. Ann Intern Med December 19, 2006 vol. 145 no. 12 895-900
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