Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California 90073, USA.
Am J Gastroenterol. 2011 May;106(5):875-83. doi: 10.1038/ajg.2011.75. Epub 2011 Apr 12.
The success of colonoscopy depends on high-quality bowel preparation by patients; yet inadequate preparation is common. We developed and tested an educational booklet to improve bowel preparation quality.
We conducted patient cognitive interviews to identify knowledge and belief barriers to colonoscopy preparation. We used these interviews to create an educational booklet to enhance preparatory behaviors. We then prospectively randomized patients scheduled for outpatient colonoscopy at a VA Medical Center to receive usual instructions vs. the booklet before colonoscopy. Patients in both groups received standard pharmacy instructions for single-dose bowel preparation; the protocol did not specify which purgatives to prescribe. The primary outcome was preparation quality based on blinded ratings using the validated Ottawa score. We performed bivariate analyses to compare mean scores between groups using a t-test, and logistic regression to measure the booklet effect on preparation quality, adjusting for potential confounders.
A total of 436 patients were randomized between arms. In an intention-to-treat analysis of the primary outcome, mean Ottawa scores were superior in patients allocated to booklet vs. controls (P=0.03). An intention-to-treat analysis of the secondary outcome revealed a "good" preparation in 68 vs. 46% of booklet and control patients, respectively (P=0.054). In a per-protocol analysis limited to patients who actually received the booklet, preparation was good in 76 vs. 46% patients, respectively (P<0.00001). Regression analysis revealed that booklet receipt increased the odds of good preparation by 3.7 times (95% confidence interval=2.3-5.8).
Provision of a novel educational booklet considerably improves preparation quality in patients receiving single-dose purgatives. The effect of the booklet on split-dose purgatives remains untested and will be evaluated in future research.
结肠镜检查的成功与否取决于患者进行高质量的肠道准备；然而，肠道准备不充分的情况很常见。我们开发并测试了一种教育手册，以提高肠道准备质量。
我们对患者进行了认知访谈，以确定结肠镜准备过程中的知识和信念障碍。我们利用这些访谈结果编写了一本教育手册，以增强准备行为。随后，我们前瞻性地将在退伍军人事务医疗中心接受门诊结肠镜检查的患者随机分为接受常规指导与接受手册指导两组。两组患者均接受标准药房单剂量肠道准备用药说明；方案未具体规定使用哪种泻药。主要结局指标是使用经过验证的渥太华评分进行盲法评估的肠道准备质量。我们使用 t 检验对组间平均评分进行了双变量分析，并使用逻辑回归测量手册对肠道准备质量的影响，同时调整了潜在的混杂因素。
共有 436 名患者被随机分配至两组。在对主要结局的意向性治疗分析中，接受手册指导的患者的平均渥太华评分优于对照组（P=0.03）。对次要结局的意向性治疗分析显示，接受手册指导的患者中“良好”准备的比例为 68%，而对照组为 46%（P=0.054）。在仅限于实际接受手册的患者的方案分析中，分别有 76%和 46%的患者准备良好（P<0.00001）。回归分析显示，接受手册指导使良好准备的几率增加了 3.7 倍（95%置信区间=2.3-5.8）。
提供一本新颖的教育手册可显著提高接受单剂量泻药的患者的肠道准备质量。手册对分剂量泻药的效果仍有待检验，将在未来的研究中进行评估。
