title: Appointment waiting times and education level influence the quality of bowel preparation in adult patients undergoing colonoscopy.
abstract: BACKGROUND
  Risk factors for poor bowel preparation are recognized to be independent of the type of bowel preparation method used. Patient and administrative factors influencing bowel preparation are known to vary in different healthcare systems.
  
  
  METHODS
  A prospective, cross-sectional study of patients undergoing colonoscopy in an Asian tertiary centre was conducted to identify risk factors associated with poor bowel preparation, and to evaluate the impact of poor bowel preparation on technical performance and patient comfort.
  
  
  RESULTS
  Data on 501 patients (mean age 60.1 ± 14.0 years old, 51.2% males, 60.9% with secondary education or higher) was available for analysis. Poor bowel preparation was present in 151 patients (30.1%). Lower education level (OR = 2.35, 95% CI = 1.54 - 3.60), colonoscopy appointment waiting time beyond 16 weeks (OR = 1.86, 95% CI = 1.04 - 3.37) and non-adherence to bowel preparation instructions (OR = 4.76, 95% CI = 3.00 - 7.55) were identified as independent risk factors for poor bowel preparation. Poor bowel preparation was associated with a lower cecal intubation rate (78.1% versus 98.3%, p < 0.001), prolonged total colonoscopy time (25.4 ± 12.6 minutes versus 16.7 ± 10.2 minutes, p < 0.001), and increased patient discomfort during colonoscopy (patient with moderate to severe abdominal discomfort 31.8% versus 3.2%, p < 0.001).
  
  
  CONCLUSIONS
  Education levels and appointment waiting times, in addition to non-adherence to bowel preparation instructions, increase the risk of poor bowel preparation in adult patients undergoing colonoscopy. The latter has a significant impact on colonoscopy performance and patient comfort.
authors.affiliation: Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia. wahkheong2003@hotmail.com
authors.forename: Wah-Kheong
authors.initials: WK
authors.lastname: Chan
authors.forename: Arjunan
authors.initials: A
authors.lastname: Saravanan
authors.forename: Jeeta
authors.initials: J
authors.lastname: Manikam
authors.forename: Khean-Lee
authors.initials: KL
authors.lastname: Goh
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Mahadeva
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D002400:Cathartics / Q000008:administration & dosage*; D015331:Cohort Studies; D003108:Colonic Diseases / Q000175:diagnosis; D003113:Colonoscopy / Q000592:standards*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012307:Risk Factors; D014850:Waiting Lists
chemical_list: D002400:Cathartics