Predicting adherence to colonoscopy or flexible sigmoidoscopy on the basis of physician appointment-keeping behavior.
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.


METHODS
Retrospective cohort.


METHODS
23 sites performing endoscopic procedures in a health care system.


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


METHODS
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 (< or =65%) was the only statistically significant predictor of attending the rescheduled study (adjusted odds ratio, 0.87 [CI, 0.78 to 0.98]).


CONCLUSIONS
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.


CONCLUSIONS
Physician appointment-keeping behavior predicted attendance to colorectal endoscopic studies in this cohort and may help identify persons who need interventions to promote adherence.
Turner
Barbara J
BJ
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. bturner@mail.med.upenn.edu
Weiner
Mark
M
Yang
Chuya
C
TenHave
Thomas
T
D000368:Aged; D001071:Appointments and Schedules; D015331:Cohort Studies; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D012812:Sigmoidoscopy; D012959:Socioeconomic Factors