Even when primary care physicians have face-to-face discussions with patients before making screening colonoscopy referrals, nonadherence can be substantial.
Often, primary care physicians lack sufficient time to educate patients and address their potential misconceptions, and fears about this procedure.
Dr Thomas Denberg and colleagues from Colorado evaluated an innovative approach to increasing patient compliance with completion of the colonoscopy procedure.
The team of doctors assessed whether an informational brochure sent to patients' home addresses after referral for colonoscopy would increase patient compliance.
The doctors conducted a randomized, controlled trial conducted in 2 general internal medicine practices.
|The adherence rate was 12 percentage points greater with mailed brochures|
|Annals of Internal Medicine|
The trial included 781 consecutive patients 50 years of age or older referred by their primary care physicians for screening colonoscopy.
The doctors randomly assigned patients to a control group that received usual care.
The intervention group received usual care plus an informational brochure.
The brochure was mailed within 10 days of referral for screening colonoscopy.
The team reported that the brochure mentioned the name of the patient's primary care physician, and encouraged patients to schedule a procedure.
The questionnaire also described colorectal cancer and polyps, and the similar lifetime risks for colorectal cancer for men and women.
In addition, colonoscopy and risk for perforation, the nature of bowel preparation for the procedure, and alternative screening tests were described.
The doctors then measured that rates of adherence to screening colonoscopy in the 2 study groups.
The team found that the overall adherence rate was 12 percentage points greater in the intervention group than in the control group.
The doctors observed that older patients were more adherent than younger patients.
The team noted that patients with low-income insurance plans, such as Medicaid, were less adherent despite being sent a brochure.
The team reported that the small number of clinical practices, and minority patients may limit generalizability of their study.
The team did not determine the degree to which adherence was influenced by a reminder to schedule a procedure vs detailed information about colonoscopy.
Dr Denberg's team concludes, “An inexpensive mailed brochure is an effective way to increase patient adherence to primary care physician referral for screening colonoscopy.”