Understanding Gastroenterologist Adherence to Polyp Surveillance Guidelines

Shah, Tilak; Voils, Corrine I.; McNeil, Rebecca B.; Wu, Richard; Fisher, Deborah A.

doi:10.1038/ajg.2012.59

Cited by 31 publications

(23 citation statements)

References 23 publications

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“…In a survey 17 of a nationally representative sample of gastroenterologists and surgeons regarding their attitudes toward frequency of surveillance after polypectomy, physicians frequently recommended surveillance colonoscopy earlier than specified by guidelines. Other physician surveys 29–31 show many endoscopists either lack knowledge regarding follow-up recommendations or disagree with guidelines. Most of these studies focus exclusively on recommendations and lack follow-up data on whether patients undergo repeat exams, which precludes the ability to examine the association between physician recommendation and colonoscopy receipt.…”

Section: Discussionmentioning

confidence: 99%

Underuse and Overuse of Colonoscopy for Repeat Screening and Surveillance in the Veterans Health Administration

Murphy

Sandler

Grubber

et al. 2016

Clinical Gastroenterology and Hepatology

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Background & Aims Regular screening with colonoscopy lowers colorectal cancer incidence and mortality. We aimed to determine patterns of repeat and surveillance colonoscopy and identify factors associated with over- and underuse of colonoscopy. Methods We analyzed data from participants in a previous Veterans Health Administration (VHA) study who underwent outpatient colonoscopy at 25 VHA facilities between October 2007 and September 2008 (n=1455). The proportion of patients who received a follow-up colonoscopy was calculated for 3 risk groups, defined based on the index colonoscopy: no adenoma, low-risk adenoma, or high-risk adenoma. Results Colonoscopy was overused (used more frequently than intervals recommended by guidelines) by 16% of patients with no adenomas, 26% with low-risk adenomas, and 29% with high-risk adenomas. Most patients with high-risk adenomas (54%) underwent colonoscopy after the recommended interval or did not undergo colonoscopy. Patients who received a follow-up recommendation that was discordant with guidelines were more likely to undergo colonoscopy too early (no adenoma odds ratio [OR], 3.80; 95% CI, 2.31–6.25 and low-risk adenoma OR, 5.28; 95% CI, 1.88–14.83). Receipt of colonoscopy at non-academic facilities was associated with overuse among patients without adenomas (OR, 5.26; 95% CI, 1.96–14.29) or with low-risk adenomas (OR, 3.45; 95% CI, 1.52–7.69). Performance of colonoscopies by general surgeons vs gastroenterologists (OR, 2.08; 95% CI, 1.02–4.23) and female sex of the patient (OR, 3.28; 95% CI, 1.06–10.16) were associated with overuse of colonoscopy for patients with low-risk adenomas. No factors examined were associated with underuse of colonoscopy among patients with high-risk adenomas. Conclusions In an analysis of patients in the VHA system, more than a quarter of patients with low-risk adenomas received a follow-up colonoscopies too early, whereas more than half of those with high-risk adenomas did not undergo surveillance colonoscopy as recommended. Our findings highlight the need for system-level improvements to facilitate the appropriate delivery of colonoscopy based on individual risk.

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Section: Discussionmentioning

confidence: 99%

Underuse and Overuse of Colonoscopy for Repeat Screening and Surveillance in the Veterans Health Administration

Murphy

Sandler

Grubber

et al. 2016

Clinical Gastroenterology and Hepatology

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“…Also brought out were concerns about physician discipline and reimbursement effects of guidelines. [6] In our survey, the reasons provided by physicians for not following recent guidelines can assist in targeting educational efforts for physicians. For example, a reason cited by some was difficulty in recalling the guidelines, which can be addressed by a simple quality improvement measure such as posting the guidelines in the endoscopy room or incorporating reminders in endoscopy documentation software.…”

Section: Discussionmentioning

confidence: 99%

“…The VA study also showed higher percentages of self-reported guideline adherence than guideline-concordant responses by the knowledge-based assessment. [6] Quality indicators have recommended that a reason should be documented if surveillance guidelines are not to be followed, but in practice this is rarely done. [19]…”

Section: Discussionmentioning

confidence: 99%

“…[5] In 2010, a VA-only study of gastroenterologists testing the knowledge of 2006 guidelines showed a high proportion of physicians recommending intervals shorter or longer than guideline recommendations. [6] Two recent studies have shown that surveillance colonoscopy is overused in low-risk individuals and under-used in high risk patients in both academic and community settings. [7,8]…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Poor Adherence of US Gastroenterologists with Colonoscopy Screening and Surveillance Guidelines

et al. 2014

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Background The U.S. Multi-Society Task Force on Colorectal Cancer published guidelines for colonoscopy screening and surveillance in 2008 and affirmed them in 2012. Characteristics associated with guideline adherence among U.S. gastroenterologists have not been assessed. Aims Assess awareness and adherence of U.S. gastroenterologists with national guidelines for colonoscopy screening and surveillance and predictors of adherence to guidelines. Methods A web-based survey was administered to gastroenterologists in various practice settings across the United States. Results A total of 306 gastroenterologists completed the survey; 86% reported awareness of the guidelines. Low-volume colonoscopists (<20 /month) were less likely to be aware of the guidelines (OR 0.26, p=0.03) compared to high-volume colonoscopists (>100/month). Those completing training before 1990 were less likely to report following guidelines (OR 0.37, p=0.01). Adherence with guidelines was then assessed via clinical scenarios. Compared to physicians finishing training in 1991-2010, less adherence was seen in those finishing before 1990 (OR 0.75, p<0.001) or currently in training (OR 0.72, p=0.004). Compared to the Western U.S., less adherence was seen in the Midwest (OR 0.69, p=0.001), Northeast (OR 0.63, p<0.001), and South (OR 0.59, p<0.001). Lower adherence was seen among non-academic physicians (OR 0.72, p=0.001) and low-volume colonoscopists (OR 0.52, p<0.001). Conclusions There is poor adherence with colonoscopy screening and surveillance guidelines among U.S. gastroenterologists. Poor adherence was associated with being in training or finishing training before 1990, practicing in the South, non-academic settings, and low colonoscopy volume. These findings can target interventions for quality improvement in colorectal cancer screening and surveillance.

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“…20 Overuse and underuse of colonoscopy seem to be common. 5,21 Nonadherence may occur even among gastroenterologists with an understanding of guideline recommendations.…”

Section: Adherence To Surveillance Colonoscopy Recommendations By Colmentioning

confidence: 98%

Recommended Intervals Between Screening and Surveillance Colonoscopies

Baron

Smyrk

Rex

2013

Mayo Clinic Proceedings

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Colonoscopy has become the mainstay for screening and surveillance of colorectal cancer. The guidelines for screening and surveillance colonoscopy have recently been updated, particularly in light of greater recognition of the importance of sessile serrated lesions in the role of cancer. It is important for practitioners to be aware of and understand the recommendations for screening and surveillance to optimize patient safety and to decrease health care use. We searched PubMed for articles and guidelines related to screening and surveillance of colonic polyps and serrated adenomas. The related citations feature was also used. The search was conducted from February 22, 2013, to March 2, 2013, and we included the search terms colorectal cancer screening, colonoscopy, guidelines, colorectal polyps, and colorectal surveillance. We selected the most recent guidelines and pertinent articles for this review, in which we discuss the basis of screening and surveillance colonoscopy and provide recommendations for colonoscopy intervals.

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Understanding Gastroenterologist Adherence to Polyp Surveillance Guidelines

Cited by 31 publications

References 23 publications

Underuse and Overuse of Colonoscopy for Repeat Screening and Surveillance in the Veterans Health Administration

Underuse and Overuse of Colonoscopy for Repeat Screening and Surveillance in the Veterans Health Administration

Predictors of Poor Adherence of US Gastroenterologists with Colonoscopy Screening and Surveillance Guidelines

Recommended Intervals Between Screening and Surveillance Colonoscopies

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