title: Physician recommendations and patient adherence after inadequate bowel preparation on screening colonoscopy.
abstract: OBJECTIVE
  It has been suggested that bowel preparation quality may influence decision-making about appropriate follow-up interval after screening colonoscopy. We sought: (1) to assess physician recommendations for timing of subsequent colonoscopy in average-risk patients with inadequate bowel preparation on initial screening, and (2) to measure the association between physician recommendations and patient adherence to repeat colonoscopy.
  
  
  METHODS
  Patients undergoing average-risk screening colonoscopy from 2004 to 2009 found to have inadequate bowel preparation were identified. Physician recommendations for timing of subsequent colonoscopy and patient adherence to repeat colonoscopy were assessed through examination of endoscopy records. Data from repeat colonoscopies were collected through August 2010.
  
  
  RESULTS
  There were 373 patients with inadequate bowel preparation on initial screening colonoscopy. There was a wide range of physician recommendations for timing of repeat colonoscopy: next day (4.6 % of patients), 2 days to 6 months (9.9 %), 7 months to 1 year (34.0 %), 2-5 years (38.3 %), 6-10 years (5.1 %), and timing not specified (8.0 %). Physicians were significantly more likely to recommend repeat colonoscopy within 1 year if any polyps were detected (OR = 2.2, p = 0.001). Patients instructed to have next day follow-up were significantly more likely to adhere to the recommendation compared to patients who were instructed to return after longer intervals (OR 4.4, p = 0.005).
  
  
  CONCLUSIONS
  Patients with inadequate bowel preparation on screening colonoscopy were subject to a wide range of physician recommendations for follow-up. Patient adherence to physician recommendations was significantly higher when repeat colonoscopy was recommended the next day.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA. rchokshi@uchc.edu
authors.forename: Reena V
authors.initials: RV
authors.lastname: Chokshi
authors.forename: Christine E
authors.initials: CE
authors.lastname: Hovis
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
authors.forename: Dayna S
authors.initials: DS
authors.lastname: Early
authors.forename: Jean S
authors.initials: JS
authors.lastname: Wang
mesh_terms: D002400:Cathartics / Q000008:administration & dosage*; D003111:Colonic Polyps / Q000175:diagnosis*; D003113:Colonoscopy; D003657:Decision Making; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D002400:Cathartics
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