title: Effect of a mailed brochure on appointment-keeping for screening colonoscopy: a randomized trial.
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.
  
  
  METHODS
  Randomized, controlled trial.
  
  
  METHODS
  2 general internal medicine practices affiliated with the University of Colorado Health Sciences Center.
  
  
  METHODS
  781 consecutive patients 50 years of age or older referred by their primary care physicians for screening colonoscopy.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Colorado at Denver and Health Sciences Center, Denver, Colorado 80262, USA. tom.denberg@uchsc.edu
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Denberg
authors.forename: John M
authors.initials: JM
authors.lastname: Coombes
authors.forename: Tim E
authors.initials: TE
authors.lastname: Byers
authors.forename: Alfred C
authors.initials: AC
authors.lastname: Marcus
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Feinberg
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Ahnen
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D003113:Colonoscopy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010174:Pamphlets; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods*