Perspectives of primary care providers and endoscopists about current practices, facilitators and barriers for preparation and follow-up of colonoscopy procedures: a qualitative study

Abstract

BackgroundColonoscopy has become a common medical procedure due to increased use of colonoscopy for evaluation of symptoms, colorectal cancer screening and surveillance of people with higher risks of developing colorectal cancer. Timely access to colonoscopy is essential for diagnosis of colorectal cancer, as well as diagnosis and management of inflammatory bowel disease and gastrointestinal symptoms such as diarrhea. The purpose of this study was to obtain the perspectives of primary care providers and endoscopists about current practices, barriers and facilitators to following recommended practice for preparation and follow-up after colonoscopy. We also aimed to obtain recommendations for approaches to improve the process.MethodsSix focus groups (two with gastroenterologists, two with surgeons who perform colonoscopies and two with primary care providers) were held between October 2015 and January 2016. Analysis was performed using inductive qualitative approaches.ResultsVariations and challenges in communication for continuity of care and understanding the distribution of responsibility were identified, as were perceived benefits and challenges of a central intake system for colonoscopies. Recommendations were made to improve processes including strengthening communication and information sharing. A comprehensive quality improvement plan would facilitate implementation of recommendations.ConclusionsFindings emphasize the need for improved patient-focused information resources for each step of the colonoscopy process and improved communication among practitioners. The findings apply to other services requiring collaboration among patients, primary care providers, and medical specialists.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3567-y) contains supplementary material, which is available to authorized users.

Patient Satisfaction with Colonoscopy Without a Preprocedure Visit

“…Other endoscopists support OACs, as it allows for a more pragmatic utilization of clinic time and avoids repeating a workup that is often already completed by the referring general practitioner. 4 In this study, satisfaction and preparedness were not affected by whether a patient had a preprocedure visit. These findings support the notion that office visits do not need to be mandated for most patients, eliminating the inconvenience and cost.…”

“…Research into the barriers of compliance have implicated cost and time as causative factors, and preprocedure office visits have specifically been shown to contribute to both these barriers. 2,4 In response, many health care facilities have implemented OAC programs. These allow healthy patients to undergo screening colonoscopies without an initial office visit.…”

Clinician based decision tool to guide recommended interval between colonoscopies: development and evaluation pilot study

“…They disagreed about whose responsibility it was to ensure that patient intervals were adhered to. Previous research has identified the complex and inconsistent nature of the communication among endoscopists, PCPs and patients [ 41 ]. Results from the current study support the development of standardized processes for communication and tracking of surveillance colonoscopies.…”

Evaluación de la satisfacción del paciente sometido a colonoscopia de escrutinio y la calidad del procedimiento

“…Las actuales guías y consensos recomiendan que la colonoscopia es el método estándar de referencia para la detección de lesiones colorrectales en sujetos con riesgo promedio. Existe evidencia de que en sujetos asintomáticos la detección y la remoción de las lesiones precursoras (adenomas) mediante colonoscopia puede reducir la incidencia y reducir la mortalidad asociada a cáncer 7,10,11 .…”