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Physician Reminders to Promote Surveillance Colonoscopy for Colorectal Adenomas

A Randomized Controlled Trial

  • Original Article
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Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Most colorectal cancers develop from adenomatous polyps. National guidelines recommend surveillance colonoscopy within 5 years after such polyps are removed.

Objective

To determine whether surveillance colonoscopy can be increased among overdue patients by reminders to their primary physicians.

Design

Randomized, controlled trial of patient-specific reminders mailed to 141 physicians in 2 Massachusetts primary care networks during April, 2006.

Patients

Seven hundred seventeen patients who had colorectal adenomas removed during 1995 through 2000 and no follow-up colonoscopy identified via automated review of electronic records through March, 2006.

Measurements and Main Results

The use of colonoscopy and detection of new adenomas or cancer were assessed at 6 months by a blinded medical record review in all patients. Among 358 patients whose physicians received reminders, 33 (9.2%) patients underwent colonoscopy within 6 months, compared with 16 (4.5%) of 359 patients whose physicians did not receive reminders (P = 0.009). In prespecified subgroups, this effect did not differ statistically between 2 primary care networks, elderly and nonelderly patients, or women and men (all P > 0.60 by Breslow–Day test). New adenomas or cancer were detected in 14 (3.9%) intervention patients and 6 (1.7%) control patients (P = 0.06), representing 42.4% and 37.5% of patients who underwent colonoscopy in each group, respectively. Despite using advanced electronic health records to identify eligible patients, 22.5% of enrolled patients had a prior follow-up colonoscopy ascertained only by visual record review, and physicians reported 27.9% of intervention patients were no longer active in their practice.

Conclusions

Among patients with prior colorectal adenomas, physician reminders increased the use of surveillance colonoscopy, but better systems are needed to identify eligible patients (ClinicalTrials.gov ID number NCT00397969).

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Acknowledgments

We are grateful to David H. Stockwell, M.D., M.P.H. for advice on the study design; Julie Fiskio and James Morrissey for providing electronic data from Brigham and Women’s Hospital and Harvard Vanguard Medical Associates, respectively; Deborah Collins for coordinating the study mailings to physicians and tabulating their responses; Asaf Bitton, M.D. and Jeffrey Kullgren, M.D., M.P.H. for reviewing medical records; and Robert E. Wolf, M.S. for assisting with statistical analyses. This study was supported by a grant (R21-CA112365) from the National Cancer Institute.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    John Z. Ayanian MD, MPP & Thomas D. Sequist MD, MPH

  2. Division of Gastroenterology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Richard S. Johannes MD, MS

  3. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    John Z. Ayanian MD, MPP, Thomas D. Sequist MD, MPH & Alan M. Zaslavsky PhD

  4. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA

    John Z. Ayanian MD, MPP

  5. Harvard Vanguard Medical Associates, Boston, MA, USA

    Thomas D. Sequist MD, MPH

  6. Cardinal Health, Westborough, MA, USA

    Richard S. Johannes MD, MS

Authors
  1. John Z. Ayanian MD, MPP
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  2. Thomas D. Sequist MD, MPH
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  3. Alan M. Zaslavsky PhD
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  4. Richard S. Johannes MD, MS
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Corresponding author

Correspondence to John Z. Ayanian MD, MPP.

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Ayanian, J.Z., Sequist, T.D., Zaslavsky, A.M. et al. Physician Reminders to Promote Surveillance Colonoscopy for Colorectal Adenomas. J GEN INTERN MED 23, 762–767 (2008). https://doi.org/10.1007/s11606-008-0576-2

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  • DOI: https://doi.org/10.1007/s11606-008-0576-2

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