Steiner, John F., Nguyen, Anh P., Schuster, Kelly S., Goodrich, Glenn, Barrow, Jennifer, Steiner, Claudia A., and Zeng, Chan
Background: Missed colonoscopy appointments delay screening and treatment for gastrointestinal disorders. Prior nonadherence with other care components may be associated with missed colonoscopy appointments. Objective: To assess variability in prior adherence behaviors and their association with missed colonoscopy appointments. Design: Retrospective cohort study. Participants: Patients scheduled for colonoscopy in an integrated healthcare system between January 2016 and December 2018. Main Measures: Prior adherence behaviors included: any missed outpatient appointment in the previous year; any missed gastroenterology clinic or colonoscopy appointment in the previous 2 years; and not obtaining a bowel preparation kit pre-colonoscopy. Other sociodemographic, clinical, and system characteristics were included in a multivariable model to identify independent associations between prior adherence behaviors and missed colonoscopy appointments. Key Results: The median age of the 57,590 participants was 61 years; 52.8% were female and 73.4% were white. Of 77,684 colonoscopy appointments, 3,237 (4.2%) were missed. Individuals who missed colonoscopy appointments were more likely to have missed a previous primary care appointment (62.5% vs. 38.4%), a prior gastroenterology appointment (18.4% vs. 4.7%) or not to have picked up a bowel preparation kit (42.4% vs. 17.2%), all p < 0.001. Correlations between the three adherence measures were weak (phi < 0.26). The rate of missed colonoscopy appointments increased from 1.8/100 among individuals who were adherent with all three prior care components to 24.6/100 among those who were nonadherent with all three care components. All adherence variables remained independently associated with nonadherence with colonoscopy in a multivariable model that included other covariates; adjusted odds ratios (with 95% confidence intervals) were 1.6 (1.5–1.8) for outpatient appointments, 1.9 (1.7–2.1) for gastroenterology appointments, and 3.1 (2.9–3.4) for adherence with bowel preparation kits, respectively. Conclusions: Three prior adherence behaviors were independently associated with missed colonoscopy appointments. Studies to predict adherence should use multiple, complementary measures of prior adherence when available. [ABSTRACT FROM AUTHOR]