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Predicting Adherence to Colonoscopy or Flexible Sigmoidoscopy on the Basis of Physician Appointment–Keeping Behavior

Barbara J. Turner, MD, MSEd; Mark Weiner, MD; Chuya Yang, MS; and Thomas TenHave, PhD
[+] Article, Author, and Disclosure Information

From University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Presented at the 25th Annual Meeting of the Society of General Internal Medicine, Atlanta, Georgia, 2–4 May 2002.

Requests for Single Reprints: Barbara J. Turner, MD, MSEd, University of Pennsylvania, 1123 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; e-mail, bturner@mail.med.upenn.edu.

Potential Financial Conflicts of Interest: None disclosed.

Current Author Addresses: Dr. Turner: University of Pennsylvania, 1123 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.

Drs. Weiner and TenHave: University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104.

Ms. Yang: University of Pennsylvania, 1135 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.

Author Contributions: Conception and design: B.J. Turner, M. Weiner.

Analysis and interpretation of the data: B.J. Turner, M. Weiner, T. TenHave.

Drafting of the article: B.J. Turner.

Critical revision of the article for important intellectual content: B.J. Turner, M. Weiner, T. TenHave.

Final approval of the article: B.J. Turner, M. Weiner, T. TenHave, C. Yang.

Provision of study materials or patients: M. Weiner.

Statistical expertise: T. TenHave.

Administrative, technical, or logistic support: M. Weiner,

Collection and assembly of data: M. Weiner, C. Yang.

Ann Intern Med. 2004;140(7):528-532. doi:10.7326/0003-4819-140-7-200404060-00013
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For the 13 142 identified patients with a first colon study appointment from June 1999 through November 2001, we excluded patients with fewer than 3 physician visits in the preceding 2 years (n= 1258) because having few visits limited our examination of physician visit adherence. Other exclusions included death within study time frame (n= 73), missing sex data (n= 2), and no arrived visits to yield clinical data (n= 6). Persons with few physician visits had slightly higher adherence to the first colon study (64%) than did study participants (61%).

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Non-adherence to keeping colonoscopy appointments may have a reason!
Posted on May 5, 2004
Edward L Arsura
Salem Veterans Affairs Medical Center, University of Virginia
Conflict of Interest: None Declared

Letter to the Editor,

We read with interest the article by Turner etal. (1), regarding predicting adherence to colonoscopy appointments. Their observations are important, however they may not be translatable to the entire population. We would like to share our experiences at a Veterans Affairs Medical Center.

Data was collected from January of 2003 to December of 2003 for all the patients scheduled for colonoscopy, 1932 patients. 1366 patients under went colonoscopy. 216 patients were rescheduled by the physicians for various reasons, 153 patients rescheduled the their own appointments, and there were 197 no shows. 94% of our colonoscopy patients were male with a mean age of 64.1 years. 14% had ethanol related issues. Only 9% pf the patients had missed prior scheduled appointments in other areas and this was no different from our population as a whole. Almost all had multiple comorbidities and 85% for the procedures were for indications other than age appropriate screening.

Of the 197 no shows, 92 of them provided personal reasons for missing their appointments including distance from the hospital, reliance on family members for transportation who were unavailable on the day of procedure, difficulty with the pre- procedure preparation. 14 patients cancelled and rescheduled because of poor weather conditions. 15 patients died before their appointment date. Five patients had read directions to the endoscopy area incorrectly and 2 received incorrect scheduling information in the mail. Three patients were acutely ill and one refused to have the procedure done and did not show up. No further definitive information was provided by the remainder although a number were still in the contemplative mode with regard to colonoscopy.

Our data shows that for our patients who did not adhere to colonoscopy appointment for the scheduled procedures clinic attendance was not as important in Turner et al.'s population (1). The current group generally had some personal reasons as described above. Weather is not a major determining factor for the no shows, but should be considered. A large multicentered trial determining the reasons for the patient's non- adherence may be helping us to better use our limited available resources.


1. Turner BJ, Weiner M, Yang C, TenHave T. Predicting adherence to colonoscopy or flexible sigmoidoscopy on the basis of physician appointment-keeping behavior. Ann Intern Med. 2004 Apr 6; 140(7):528-32.

Conflict of Interest:

None declared

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Summary for Patients

Why Some People Do Not Show Up for Planned Colorectal Cancer Screening

The summary below is from the full report titled “Predicting Adherence to Colonoscopy or Flexible Sigmoidoscopy on the Basis of Physician Appointment–Keeping Behavior.” It is in the 6 April 2004 issue of Annals of Internal Medicine (volume 140, pages 528-532). The authors are B.J. Turner, M. Weiner, C. Yang, and T. TenHave.


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