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Overcoming Poor Attendance to First Scheduled Colonoscopy: A Randomized Trial of Peer Coach or Brochure Support

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Abstract

OBJECTIVES

Among patients unlikely to attend a scheduled colonoscopy, we examined the impact of peer coach versus educational brochure support and compared these with concurrent patients who did not receive support.

METHODS

From health system data, we identified 275 consecutive patients aged >50 who kept <75% of visits to 4 primary care practices and scheduled for a first colonoscopy from February 1, 2005 to August 31, 2006. Using block randomization, we assigned consenting patients to a phone call by a peer coach trained to address barriers to attendance or to a mailed colonoscopy brochure. Study data came from electronic medical records. Odds ratios of colonoscopy attendance were adjusted for demographic, clinical, and health care factors.

RESULTS

Colonoscopy attendance by the peer coach group (N = 70) and brochure group (N = 66) differed by 11% (68.6% vs 57.6%, respectively). Compared with the brochure group, the peer coach group had over twofold greater adjusted odds ratio (AOR) of attendance (2.14, 95% confidence interval [CI] = 0.99–4.63) as did 49 patients who met the prespecified criteria for needing no support (2.68, 95%CI = 1.05–6.82) but the AORs did not differ significantly for 41 patients who declined support (0.61, 95%CI = 0.25–1.45) and 49 patients who could not be contacted (0.85, 95%CI = 0.36–2.02). Attendance was less likely for black versus white race (AOR = 0.37, 95%CI = 0.19–0.72) but more likely for patients with high versus low primary care visit adherence (AOR = 2.30, 95%CI = 1.04–5.07).

CONCLUSION

For patients who often fail to keep appointments, peer coach support appears to promote colonoscopy attendance more than an educational brochure.

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Acknowledgements

We would like to thank our funding source, Presbyterian Medical Center’s Bach Fund. We would also like to honor the memory of Radhika Srinivasan MD who contributed her expertise to training the peer coaches. We also thank David Weinberg, MD, MSCE for the comments on an earlier draft of the paper and our hardworking peer coaches.

Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Barbara J. Turner MD, MSED, Mark Weiner MD, Sheila D. Berry & Kevin Fosnocht MD

  2. Departments of Surgery and Health Evaluation Sciences, Penn State College of Medicine, Hershey, PA, USA

    Christopher S. Hollenbeak PhD

  3. Princeton University, Princeton, NJ, USA

    Karen Lillie

Authors
  1. Barbara J. Turner MD, MSED
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  2. Mark Weiner MD
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  3. Sheila D. Berry
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  4. Karen Lillie
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  5. Kevin Fosnocht MD
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  6. Christopher S. Hollenbeak PhD
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Corresponding author

Correspondence to Barbara J. Turner MD, MSED.

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Turner, B.J., Weiner, M., Berry, S.D. et al. Overcoming Poor Attendance to First Scheduled Colonoscopy: A Randomized Trial of Peer Coach or Brochure Support. J GEN INTERN MED 23, 58–63 (2008). https://doi.org/10.1007/s11606-007-0445-4

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  • DOI: https://doi.org/10.1007/s11606-007-0445-4

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