Patient-, Provider-, and System-Level Factors in Low Adherence to Surveillance Colonoscopy Guidelines: Implications for Future Interventions

Braschi, Caitlyn; Pelto, Debra J.; Hennelly, Marie Oliva; Lee, Kristen K.; Shah, Brijen J.; Montgomery, Guy H.; Itzkowitz, Steven H.; Jandorf, Lina

doi:10.1007/s12029-014-9653-4

Cited by 11 publications

(7 citation statements)

References 8 publications

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“…Several small, single-institution studies have looked at predictors of surveillance colonoscopy (15, 16). In one of these, Murphy et al examined risk factors for underuse of surveillance colonoscopy, conducting telephone surveys with 100 people with a prior adenoma (not necessarily an advanced adenoma) who did not complete their surveillance colonoscopy and 104 patients who did (16).…”

Section: Discussionmentioning

confidence: 99%

“…Comorbidity was not related to receipt of surveillance colonoscopy. Braschi et al studied 103 patients with either 1 advanced adenoma, cancer, or ≥3 adenomas of any type (15); only 21% received a colonoscopy within 3 years, and this was not related to patient sex, race/ethnicity or insurance status. However, patients who had at least one primary care provider visit within a year of their surveillance due date were more likely to receive a colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

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Receipt of Colonoscopy Following Diagnosis of Advanced Adenomas: An Analysis within Integrated Healthcare Delivery Systems

Chubak

McLerran

Zheng

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: To reduce colorectal cancer incidence and mortality, experts recommend surveillance colonoscopy 3 years after advanced adenoma removal. Little is known about adherence to that interval. Methods: We describe patterns of and factors associated with subsequent colonoscopy among persons with ≥3 adenomas and/or ≥1 adenoma with villous/tubulovillous histology in four US integrated healthcare delivery systems. We report Kaplan-Meier estimators of the cumulative percentage of patients undergoing colonoscopy 6 months to 3.5 years after an index colonoscopy with high-risk findings. Combining data from three healthcare systems, we used multivariable logistic regression with inverse probability of censoring weights to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between patient characteristics and receipt of subsequent colonoscopy. Results: Among 6,909 persons with advanced adenomas, the percent receiving a subsequent colonoscopy 6 months to 3.5 years later ranged from 18.3% (95% CI: 11.7%−27.8%) to 59.5% (95% CI: 53.8%−65.2%) across healthcare systems. Differences remained significant in the multivariable model. Patients with ≥3 adenoma were more likely than those with 1–2 villous/tubulovillous adenoma to undergo subsequent colonoscopy. Subsequent colonoscopy was also more common for patients aged 60–74 and less common for patients aged 80–89 compared to those aged 50–54 years at their index colonoscopy. Sex, race/ethnicity, and comorbidity index score were generally not associated with subsequent colonoscopy receipt. Conclusions: Colonoscopy within the recommended interval following advanced adenoma was underutilized and varied by healthcare system, age, and number of adenomas. Impact: Strategies to improve adherence to surveillance colonoscopy following advanced adenomas are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Receipt of Colonoscopy Following Diagnosis of Advanced Adenomas: An Analysis within Integrated Healthcare Delivery Systems

Chubak

McLerran

Zheng

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…We believe that the importance of a PCP in adherence to recommended screening cannot be overstated. PCPs play an integral role in reinforcing screening intervals and monitoring patient compliance with surveillance colonoscopy [38]. As uninsured patients may be at higher risk for transient or inconsistent care, it is essential for this vulnerable population to be aware of their colonoscopy results and follow-up recommendations.…”

Section: Discussionmentioning

confidence: 99%

Knowledge of Polyp History and Recommended Follow-Up Among a Predominately African American Patient Population and the Impact of Patient Navigation

Fritz

Naylor

Kim

2015

J. Racial and Ethnic Health Disparities

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“…Potential reasons include poorer access to quality health insurance (3, 4), lower healthcare utilization and adherence to screening (5, 6), more financial barriers, and poorer social support (7). The goal of the following analysis was to explore a potential racial disparity in timing of clinical delay among a sample of nH Black and White colon cancer patients from the Colon Cancer Patterns of Care in Chicago (CCPCC) Study, and to examine the extent to which specific patient characteristics might help to explain the observed disparity in clinical delay.…”

Section: Introductionmentioning

confidence: 99%

Examining racial disparities in colon cancer clinical delay in the Colon Cancer Patterns of Care in Chicago study

Jones

Ferrans

Polite

et al. 2017

Annals of Epidemiology

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Purpose We explored a potential racial disparity in clinical delay among non-Hispanic (nH) Black and White colon cancer patients and examined factors that might account for the observed disparity. Methods Patients aged 30–79 with a newly diagnosed colon cancer from 2010–2014 (N=386) were recruited from a diverse sample of nine public, private and academic hospitals in and around Chicago. Prolonged clinical delay was defined as ≥60 or ≥90 days between medical presentation (symptoms or a screen-detected lesion) and treatment initiation (surgery or chemotherapy). Multivariable logistic regression with model-based standardization was used to estimate the disparity as a difference in prevalence of prolonged delay by race. Results Prevalence of delay in excess of 60 days was 12 percentage points (95% CI: 2%, 22%) higher among nH Blacks versus Whites after adjusting for age, facility and county of residence. Travel burden (time and distance traveled from residence to facility) explained roughly one-third of the disparity (33%, p=0.05),individual and area-level socioeconomic status measures explained roughly one-half (51%, p=0.21), and socioeconomic measures together with travel burden explained roughly four-fifths (79%, p= 0.08) Conclusions Low socioeconomic status and increased travel burden are barriers to care disproportionately experienced by nH Black colon cancer patients.

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Patient-, Provider-, and System-Level Factors in Low Adherence to Surveillance Colonoscopy Guidelines: Implications for Future Interventions

Cited by 11 publications

References 8 publications

Receipt of Colonoscopy Following Diagnosis of Advanced Adenomas: An Analysis within Integrated Healthcare Delivery Systems

Receipt of Colonoscopy Following Diagnosis of Advanced Adenomas: An Analysis within Integrated Healthcare Delivery Systems

Knowledge of Polyp History and Recommended Follow-Up Among a Predominately African American Patient Population and the Impact of Patient Navigation

Examining racial disparities in colon cancer clinical delay in the Colon Cancer Patterns of Care in Chicago study

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