title: An alerting system improves adherence to follow-up recommendations from colonoscopy examinations.
abstract: OBJECTIVE
  Systems are available to ensure that results of tests are communicated to patients. However, lack of adherence to recommended follow-up evaluation increases risk for adverse health outcomes and medical or legal issues. We tested the effectiveness of a novel follow-up system for patients due for surveillance colonoscopy examinations.
  
  
  METHODS
  Electronic medical records from colonoscopies performed 5 years prior were reviewed to identify individuals due for a repeat surveillance colonoscopy examination. Patients were assigned to groups that received the standard of care or a newly developed follow-up system that included a letter to the primary care provider, 2 letters to the patient, and a telephone call to patients who had not yet scheduled an examination by the procedure due date. The primary end point was the percentage of patients who scheduled or completed the colonoscopy examination within 6 months of the due date. Secondary end points included detection rate for adenomas, sex- and ethnicity-specific follow-up rates, and patient satisfaction.
  
  
  RESULTS
  Of 2609 patient records reviewed, 830 (31.8%) were found to be due for a surveillance colonoscopy examination in the study period. At the conclusion of the study, 241 (44.7%) patients in the intervention arm had procedures scheduled or completed, compared with 66 (22.6%) in the control group (P < .0001). The follow-up system appeared particularly effective among non-white patients; patients reported general satisfaction with the reminder program.
  
  
  CONCLUSIONS
  A simple protocol of letters and a telephone call to patients who are due for colonoscopy examinations significantly improved adherence to endoscopic follow-up recommendations. This work provides justification for the creation of reminder systems to improve patient adherence to medical recommendations.
authors.affiliation: Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. dleffler@caregroup.harvard.edu
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Leffler
authors.forename: Naama
authors.initials: N
authors.lastname: Neeman
authors.forename: James M
authors.initials: JM
authors.lastname: Rabb
authors.forename: Jacob Y
authors.initials: JY
authors.lastname: Shin
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.forename: Kumar
authors.initials: K
authors.lastname: Pallav
authors.forename: Z Myron
authors.initials: ZM
authors.lastname: Falchuk
authors.forename: Mark D
authors.initials: MD
authors.lastname: Aronson
mesh_terms: D003110:Colonic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D003113:Colonoscopy / Q000592:standards* / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards; D017010:Reminder Systems / Q000592:standards*; D012307:Risk Factors