Nayor Jennifer, Maniar Swapnil, Chan Walter W
Brigham and Women's Hospital, Division of Gastroenterology, Hepatology and Endoscopy, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
Brigham and Women's Hospital, Division of General Internal Medicine, 801 Massachusetts Ave, Suite 610, Boston, MA 02118, USA.
Prev Med. 2017 Apr;97:8-12. doi: 10.1016/j.ypmed.2016.12.022. Epub 2016 Dec 23.
Patient navigator programs (PNP) have been shown to improve colonoscopy completion with demonstrated cost-effectiveness. Despite additional resources available to these patients, many still do not attend their colonoscopies. The aim of this study was to determine factors associated with colonoscopy attendance amongst patients in whom logistical barriers to attendance have been minimized through enrollment in a PNP.
Retrospective case-control study of patients enrolled in a PNP for colonoscopy performed at a tertiary endoscopy center from 2009 to 2014. Cases were defined as patients who did not attend their first scheduled colonoscopy after PNP enrollment. Age- and gender-matched controls completed their first scheduled colonoscopy after PNP enrollment.
514 subjects (257 cases, mean age 57.1years, 36.6% males) were included. Patients who attended their colonoscopy were less likely to be Spanish-speaking (64.6% vs 78.2%, p=0.0003) and uninsured (0.4% vs 3.9%, p=0.006). Attendance rates were significantly lower for screening colonoscopies compared to an indication of surveillance or diagnostic (45.5% vs 65.3%, p<0.0001). Fewer patients attended colonoscopies scheduled on Monday (39.2% vs 52.1%, p=0.04) and in December (10.7% vs 52.3%, p<0.0001). On multivariate analysis, poor appointment-keeping behaviors, including a prior missed colonoscopy (OR 0.20, 95% CI 0.10-0.39) or missed office visit (OR 0.44, 95% CI 0.26-0.73) and procedures scheduled on Mondays (OR 0.51, 95% CI 0.27-0.94) were negatively associated with attendance.
Appointment-keeping behaviors, in addition to insurance-status, language-barriers and medical comorbidities, influence colonoscopy attendance in a PNP population. Patients scheduled for colonoscopies on Mondays or in December may require more resources to ensure attendance.
患者导航计划（PNP）已被证明可提高结肠镜检查的完成率，并具有成本效益。尽管这些患者可获得额外资源，但仍有许多人未进行结肠镜检查。本研究的目的是确定在通过参加PNP将就诊的后勤障碍降至最低的患者中，与结肠镜检查就诊相关的因素。
对2009年至2014年在三级内镜中心参加PNP进行结肠镜检查的患者进行回顾性病例对照研究。病例定义为参加PNP后未进行首次预定结肠镜检查的患者。年龄和性别匹配的对照在参加PNP后完成了首次预定的结肠镜检查。
纳入514名受试者（257例病例，平均年龄57.1岁，36.6%为男性）。进行结肠镜检查的患者不太可能说西班牙语（64.6%对78.2%，p = 0.0003）且未参保（0.4%对3.9%，p = 0.006）。与监测或诊断指征相比，筛查结肠镜检查的就诊率显著较低（45.5%对65.3%，p < 0.0001）。安排在周一（39.2%对52.1%，p = 0.04）和12月（10.7%对52.3%，p < 0.0001）的结肠镜检查患者就诊较少。多因素分析显示，预约遵守行为不佳，包括之前错过结肠镜检查（比值比0.20，95%置信区间0.10 - 0.39）或错过门诊就诊（比值比0.44，95%置信区间0.26 - 0.73）以及安排在周一的检查（比值比0.51，95%置信区间0.27 - 0.94）与就诊呈负相关。
除保险状况、语言障碍和合并症外，预约遵守行为会影响PNP人群的结肠镜检查就诊情况。安排在周一或12月进行结肠镜检查的患者可能需要更多资源以确保就诊。
