Physician Recommendations and Patient Adherence After Inadequate Bowel Preparation on Screening Colonoscopy
Physician Recommendations and Patient Adherence After Inadequate Bowel Preparation on Screening Colonoscopy
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DOI：
10.1007/s10620-013-2642-9
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发表时间：
2013-08-01
影响因子：
3.1
通讯作者：
Wang, Jean S.
中科院分区：
文献类型：
--
作者：
Chokshi, Reena V.;Hovis, Christine E.;Wang, Jean S.
提示肠准备质量可能影响结肠镜筛查后适当随访间隔的决策。我们寻求：(1)评估医生对初次筛查时肠道准备不足的平均风险患者后续结肠镜检查时机的建议，以及(2)衡量医生建议与患者坚持重复结肠镜检查之间的关系。2004年至2009年接受平均风险筛查结肠镜检查的患者被确定为肠道准备不足。通过检查内窥镜检查记录，评估医生对后续结肠镜检查时机的建议和患者对重复结肠镜检查的依从性。收集到2010年8月的重复结肠镜检查数据。有373例患者在初次结肠镜筛查时肠道准备不足。医生对重复结肠镜检查时间的建议范围很广：第二天（4.6%），2天至6个月（9.9%），7个月至1年（34.0%），2-5年（38.3%），6-10年（5.1%），时间未指定（8.0%）。如果发现任何息肉，医生更有可能建议在1年内重复结肠镜检查（OR = 2.2, p = 0.001）。指示第二天随访的患者与指示较长间隔后返回的患者相比，更有可能坚持建议（OR 4.4, p = 0.005）。在筛查结肠镜检查中肠准备不充分的患者接受了广泛的医生随访建议。当第二天再次进行结肠镜检查时，患者对医生建议的依从性显著提高。
It has been suggested that bowel preparation quality may influence decision-making about appropriate follow-up interval after screening colonoscopy. We sought: (1) to assess physician recommendations for timing of subsequent colonoscopy in average-risk patients with inadequate bowel preparation on initial screening, and (2) to measure the association between physician recommendations and patient adherence to repeat colonoscopy.Patients undergoing average-risk screening colonoscopy from 2004 to 2009 found to have inadequate bowel preparation were identified. Physician recommendations for timing of subsequent colonoscopy and patient adherence to repeat colonoscopy were assessed through examination of endoscopy records. Data from repeat colonoscopies were collected through August 2010.There were 373 patients with inadequate bowel preparation on initial screening colonoscopy. There was a wide range of physician recommendations for timing of repeat colonoscopy: next day (4.6 % of patients), 2 days to 6 months (9.9 %), 7 months to 1 year (34.0 %), 2-5 years (38.3 %), 6-10 years (5.1 %), and timing not specified (8.0 %). Physicians were significantly more likely to recommend repeat colonoscopy within 1 year if any polyps were detected (OR = 2.2, p = 0.001). Patients instructed to have next day follow-up were significantly more likely to adhere to the recommendation compared to patients who were instructed to return after longer intervals (OR 4.4, p = 0.005).Patients with inadequate bowel preparation on screening colonoscopy were subject to a wide range of physician recommendations for follow-up. Patient adherence to physician recommendations was significantly higher when repeat colonoscopy was recommended the next day.