A program to enhance completion of screening colonoscopy among urban minorities
A program to enhance completion of screening colonoscopy among urban minorities
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DOI：
10.1016/j.cgh.2007.12.009
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发表时间：
2008-04-01
影响因子：
12.6
通讯作者：
Itzkowitz, Steven
中科院分区：
文献类型：
--
作者：
Chew, Lea Ann;Santos, Stephanie;Itzkowitz, Steven
背景与目的：虽然结肠镜检查正在成为结直肠癌的首选筛查方法，但筛查率仍然很低，尤其是在少数族裔人群中。对筛查结肠镜检查的接受情况或少数民族中预测结肠镜检查完成情况的因素知之甚少。这项研究调查了开放式转诊系统中患者导航的使用及其对城市少数民族结肠镜检查完成率的影响。方法：这是一项在纽约一家教学医院进行的队列研究。参与者大多是2003年11月至2006年5月期间由初级保健诊所直接转介进行结肠镜检查的非裔美国人和西班牙裔美国人。一旦转诊，一位会说两种语言的西班牙裔女性患者导航员帮助完成了结肠镜检查。分析完成率、与完成结肠镜检查相关的人口统计学因素、内窥镜检查结果和患者满意度。结果：在1169名转诊患者中，688名患者符合条件，532名患者接受了导航。三分之二(66%)的导航患者完成了结肠镜检查，16%的患者有腺瘤，只有5%的患者肠道准备不足。女性完成结肠镜检查的可能性是男性的1.31倍(P=.014)。西班牙裔完成结肠镜检查的可能性是非裔美国人的1.67倍(P=.013)。西班牙裔女性完成结肠镜检查的可能性是西班牙裔男性的1.50倍(P=0.009)。患者总体满意度为98%，66%的患者报告称，如果没有导航，他们肯定或很可能不会完成结肠镜检查。结论：通过使用患者导航仪，大多数城市少数民族成功地完成了结肠镜检查，发现了临床上有意义的病理，提高了患者的满意度。这种方法可能有助于提高在其他临床环境中筛查结肠镜检查的依从性。
Background & Aims: Although colonoscopy is becoming the preferred screening test for colorectal cancer, screening rates, particularly among minorities, are low. Little is known about the uptake of screening colonoscopy or the factors that predict colonoscopy completion among minorities. This study investigated the use of patient navigation within an open-access referral system and its effects on colonoscopy completion rates among urban minorities. Methods: This was a cohort study that took place at a teaching hospital in New York. Participants were mostly African Americans and Hispanics directly referred for screening colonoscopy by primary care clinics from November 2003 to May 2006. Once referred, a bilingual Hispanic female patient navigator facilitated the colonoscopy completion. Completion rates, demographic factors associated with completing colonoscopy, endoscopic findings, and patient satisfaction were analyzed. Results: Of 1169 referrals, 688 patients qualified for and 532 underwent navigation. Two thirds (66%) of navigated patients completed screening colonoscopies, 16% had adenomas, and only 5% had inadequate bowel preps. Women were 1.31 times more likely to complete the colonoscopy than men (P=.014). Hispanics were 1.67 times more likely to complete the colonoscopy than African Americans (P=.013). Hispanic women were 1.50 times more likely to complete the colonoscopy than Hispanic men (P =.009). Patient satisfaction was 98% overall, with 66% reporting that they definitely or probably would not have completed their colonoscopy without navigation. Conclusions: By using a patient navigator, the majority of urban minorities successfully completed their colonoscopies, clinically significant pathology was detected, and patient satisfaction was enhanced. This approach may help increase adherence with screening colonoscopy efforts in other clinical settings.