Timing of Procedure and Compliance With Outpatient Endoscopy Among an Underserved Population in an Inner-City Tertiary Institution

Abstract

Purpose Anecdotal evidence suggests that patient compliance with colonoscopy is poorer with Monday procedures and better during winter months since “there is not much else to do”. We examined patients’ compliance to scheduled out-patient endoscopy by time of the day, days of the week and seasons of the year. Methods We included 2,873 patients who were scheduled for endoscopy from September 2009 to August 2010. Compliant patients were those who showed up for their procedures while non-compliant patients were those who did not show up, without canceling or rescheduling their procedures up to 24 hours prior to their scheduled procedures. We used logistic regression models to evaluate the association between the timing of the scheduled procedure and compliance. Results 574 (20%) patients did not show up. There was no difference in compliance by time of day of the procedures. However, when compared with patients scheduled for procedures on Monday, there was a trend towards improved adherence as the week progressed, becoming significant on Friday (OR=1.46; 95%CI: 1.06–2.00). There was also better compliance in the warmer months. Conclusions Non-compliance with out-patient endoscopy is substantial among underserved populations with limited predictive pattern of compliance by the timing of the procedures.

Patient Non-adherence and Cancellations Are Higher for Screening Colonoscopy Compared with Surveillance Colonoscopy

“…This is a somewhat lower rate of non-adherence than prior studies, which have reported non-adherence rates ranging from 20 to 42.4 % [5][6][7][8][9][10]. Reasons for the observed non-adherence variation from previous investigations include the heterogeneous evaluation of various types of endoscopic procedures and their indication used in prior studies [5][6][7][8][9][10]14]. Furthermore, adherence in our study was likely higher because we sought to define adherence based on patients already scheduled for their procedure.…”

“…While numerous demographic, social, and clinical variables have been shown to impact attendance to colonoscopy [5][6][7]15], our findings show that procedure indication is a relevant variable which can easily be assessed without extensive knowledge or data gathering efforts. Our findings could partly be explained by the makeup of these groups, as the screening cohort contained more African-Americans, younger individuals, and more women than the surveillance cohort; previous studies have shown higher non-adherence rates to screening colonoscopy in the aforementioned populations [5][6][7]15]. Likewise, the payer composition may reflect the differing socioeconomic status of patients undergoing screening colonoscopy versus surveillance colonoscopy, as the screening group was comprised of more Medicaid and charity care patients and less Medicare patients.…”

“…Studies have demonstrated rates of non-adherence to colonoscopy ranging from 20 to 42.4 %, suggesting this may be a barrier to screening for CRC [5][6][7][8][9][10]. Interventions such as patient education with patient navigators and physician communication training, however, can improve adherence to CRC screening [11][12][13].…”

“…Higher non-adherence rates to endoscopic procedures in general have been associated with demographic factors like minority racial and ethnic populations [5][6][7]. Furthermore, previous studies have focused on patients who were referred to complete a colonoscopy as opposed to examining adherence in patients already with a scheduled procedure [15].…”

“…Defining the subset of screening and surveillance patients at higher risk for non-adherence could focus services such as navigation programs more efficiently to increase colonoscopy adherence. Prior studies have examined adherence to colonoscopy in the setting of adherence to various endoscopic procedures in addition to colonoscopy [5][6][7][8][9][10]14]. In addition, these studies have taken place in mixed patient populations undergoing colonoscopy for various indications beyond screening and surveillance programs [5][6][7][8][9][10]14].…”