Predictors of Adherence to Post-Polypectomy Surveillance Colonoscopy

Area of Science:

• Gastroenterology
• Public Health
• Health Services Research

Background:

• Adherence to surveillance colonoscopy is crucial for preventing colorectal cancer progression.
• Safety-net hospitals serve vulnerable populations with unique barriers to care.

Purpose of the Study:

• To identify predictors of adherence to surveillance colonoscopy in a safety-net hospital setting.
• To evaluate the impact of electronic medical record (EMR) interventions on adherence.

Main Methods:

• Retrospective evaluation of average-risk patients (50-75 years) with adenomas diagnosed between 2005-2007.
• Primary outcome: on-time surveillance colonoscopy attendance within 5.5 years.
• Analysis of factors including primary care physician (PCP) visits, EMR problem list entries, and Charlson Index.

Main Results:

• Only 38.3% of 881 patients attended on-time surveillance colonoscopy.
• Increased PCP visits, "adenoma" on EMR problem list, and Charlson Index ≥1 were associated with adherence.
• "Adenoma" on EMR problem list remained a significant predictor in multivariable analysis (aOR 1.8).

Conclusions:

• A significant proportion of adenoma patients in safety-net settings do not adhere to surveillance colonoscopy.
• System-level interventions, such as adding "adenomas" to the EMR problem list, can improve adherence.
• Targeted interventions may be necessary, considering interactions between ethnicity/language and healthcare utilization.