title: Overcoming poor attendance to first scheduled colonoscopy: a randomized trial of peer coach or brochure support.
abstract: OBJECTIVE
  Among patients unlikely to attend a scheduled colonoscopy, we examined the impact of peer coach versus educational brochure support and compared these with concurrent patients who did not receive support.
  
  
  METHODS
  From health system data, we identified 275 consecutive patients aged >50 who kept <75% of visits to 4 primary care practices and scheduled for a first colonoscopy from February 1, 2005 to August 31, 2006. Using block randomization, we assigned consenting patients to a phone call by a peer coach trained to address barriers to attendance or to a mailed colonoscopy brochure. Study data came from electronic medical records. Odds ratios of colonoscopy attendance were adjusted for demographic, clinical, and health care factors.
  
  
  RESULTS
  Colonoscopy attendance by the peer coach group (N = 70) and brochure group (N = 66) differed by 11% (68.6% vs 57.6%, respectively). Compared with the brochure group, the peer coach group had over twofold greater adjusted odds ratio (AOR) of attendance (2.14, 95% confidence interval [CI] = 0.99-4.63) as did 49 patients who met the prespecified criteria for needing no support (2.68, 95% CI = 1.05-6.82) but the AORs did not differ significantly for 41 patients who declined support (0.61, 95% CI = 0.25-1.45) and 49 patients who could not be contacted (0.85, 95% CI = 0.36-2.02). Attendance was less likely for black versus white race (AOR = 0.37, 95% CI = 0.19-0.72) but more likely for patients with high versus low primary care visit adherence (AOR = 2.30, 95% CI = 1.04-5.07).
  
  
  CONCLUSIONS
  For patients who often fail to keep appointments, peer coach support appears to promote colonoscopy attendance more than an educational brochure.
authors.affiliation: Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. bturner@mail.med.upenn.edu
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
authors.forename: Mark
authors.initials: M
authors.lastname: Weiner
authors.forename: Sheila D
authors.initials: SD
authors.lastname: Berry
authors.forename: Karen
authors.initials: K
authors.lastname: Lillie
authors.forename: Kevin
authors.initials: K
authors.lastname: Fosnocht
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
mesh_terms: D001071:Appointments and Schedules; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D018802:Patient-Centered Care; D010379:Peer Group; D012657:Self-Help Groups