title: Patient-, provider-, and system-level factors in low adherence to surveillance colonoscopy guidelines: implications for future interventions.
abstract: OBJECTIVE
  Patients with a history of advanced adenomas are at increased risk of developing colorectal cancer (CRC), yet rates of adherence to current surveillance colonoscopy guidelines are poor. We determined rates of referral and adherence to 3-year interval surveillance colonoscopy in patients with advanced adenomas and identified modifiable factors as possible intervention targets to improve surveillance referral and adherence in these at-risk patients.
  
  
  METHODS
  We reviewed electronic medical records (EMR) of patients (N = 103) who had pathology findings on screening colonoscopy that warranted a 3-year surveillance colonoscopy. We abstracted demographics, surveillance colonoscopy completion rate, documentation of initial pathology in the "Problem List" of the EMR, and timing and nature of visits to a primary care physician (PCP).
  
  
  RESULTS
  Only 22 (21.4 %) patients had a record of surveillance colonoscopy completion. Among non-completers, 50.6 % of patients had no PCP visit within a year of their surveillance due date, 19.8 % saw a PCP and were not referred, and 29.6 % saw a PCP and were referred to either a gastroenterology consultation or a surveillance colonoscopy. Pathology found on initial screening was noted in the Problem List of 77.3 % of completers but only 33.3 % of non-completers (p ≤ 0.001).
  
  
  CONCLUSIONS
  Possible targets for interventions include using EMRs to improve physician communication and encouraging patients to have timely PCP visits and follow-through after colonoscopy referral. Clinical studies in this area have the potential to improve outcomes for patients by reducing CRC mortality through early detection.
authors.affiliation: Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1130, New York, NY, 10029, USA, caitlyn.braschi@mssm.edu.
authors.forename: Caitlyn
authors.initials: C
authors.lastname: Braschi
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Pelto
authors.forename: Marie O
authors.initials: MO
authors.lastname: Hennelly
authors.forename: Kristen K
authors.initials: KK
authors.lastname: Lee
authors.forename: Brijen
authors.initials: B
authors.lastname: Shah
authors.forename: Guy H
authors.initials: GH
authors.lastname: Montgomery
authors.forename: Steven H
authors.initials: SH
authors.lastname: Itzkowitz
authors.forename: Lina
authors.initials: L
authors.lastname: Jandorf
mesh_terms: D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards