Journal of General Internal Medicine

, Volume 23, Issue 6, pp 762–767

Physician Reminders to Promote Surveillance Colonoscopy for Colorectal Adenomas

A Randomized Controlled Trial
  • John Z. Ayanian
  • Thomas D. Sequist
  • Alan M. Zaslavsky
  • Richard S. Johannes
Original Article



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


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


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


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colonoscopy ascertained only by visual record review, and physicians reported 27.9% of intervention patients were no longer active in their practice.


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


colorectal neoplasms adenomatous polyps colonic polyps colonoscopy quality of health care primary health care randomized controlled trials Massachusetts 


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • John Z. Ayanian
    • 1
    • 3
    • 4
  • Thomas D. Sequist
    • 1
    • 3
    • 5
  • Alan M. Zaslavsky
    • 3
  • Richard S. Johannes
    • 2
    • 6
  1. 1.Division of General Medicine and Primary Care, Department of MedicineBrigham and Women’s HospitalBostonUSA
  2. 2.Division of Gastroenterology, Department of MedicineBrigham and Women’s HospitalBostonUSA
  3. 3.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  4. 4.Department of Health Policy and ManagementHarvard School of Public HealthBostonUSA
  5. 5.Harvard Vanguard Medical AssociatesBostonUSA
  6. 6.Cardinal HealthWestboroughUSA

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