title: Physician reminders to promote surveillance colonoscopy for colorectal adenomas: a randomized controlled trial.
abstract: BACKGROUND
  Most colorectal cancers develop from adenomatous polyps. National guidelines recommend surveillance colonoscopy within 5 years after such polyps are removed.
  
  
  OBJECTIVE
  To determine whether surveillance colonoscopy can be increased among overdue patients by reminders to their primary physicians.
  
  
  METHODS
  Randomized, controlled trial of patient-specific reminders mailed to 141 physicians in 2 Massachusetts primary care networks during April, 2006.
  
  
  METHODS
  Seven hundred seventeen patients who had colorectal adenomas removed during 1995 through 2000 and no follow-up colonoscopy identified via automated review of electronic records through March, 2006.
  
  
  RESULTS
  The use of colonoscopy and detection of new adenomas or cancer were assessed at 6 months by a blinded medical record review in all patients. Among 358 patients whose physicians received reminders, 33 (9.2%) patients underwent colonoscopy within 6 months, compared with 16 (4.5%) of 359 patients whose physicians did not receive reminders (P = 0.009). In prespecified subgroups, this effect did not differ statistically between 2 primary care networks, elderly and nonelderly patients, or women and men (all P > 0.60 by Breslow-Day test). New adenomas or cancer were detected in 14 (3.9%) intervention patients and 6 (1.7%) control patients (P = 0.06), representing 42.4% and 37.5% of patients who underwent colonoscopy in each group, respectively. Despite using advanced electronic health records to identify eligible patients, 22.5% of enrolled patients had a prior follow-up colonoscopy ascertained only by visual record review, and physicians reported 27.9% of intervention patients were no longer active in their practice.
  
  
  CONCLUSIONS
  Among patients with prior colorectal adenomas, physician reminders increased the use of surveillance colonoscopy, but better systems are needed to identify eligible patients (ClinicalTrials.gov ID number NCT00397969).
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. ayanian@hcp.med.harvard.edu
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Sequist
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.forename: Richard S
authors.initials: RS
authors.lastname: Johannes
mesh_terms: D018256:Adenomatous Polyps / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D003111:Colonic Polyps / Q000175:diagnosis*; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D011320:Primary Health Care; D017010:Reminder Systems