Predictors of Adherence to Post-Polypectomy Surveillance Colonoscopy

Objective. To identify predictors of adherence with surveillance colonoscopy at a safety-net hospital. Methods. We evaluated average-risk patients aged 50–75 with adenomas diagnosed at screening colonoscopy between 1/1/05–12/31/07. The primary outcome was on-time follow-up defined as attendance at surveillance colonoscopy within 5.5 years of screening colonoscopy. Results. Among 881 patients, of whom 38% were English-speaking non-Hispanic Blacks, 38.3% attended on-time surveillance colonoscopy. In unadjusted analyses, ≥3 PCP visits after baseline colonoscopy (OR 3.6 [2.5–5.0]), “adenoma” on the EMR problem list (OR 2.2 [1.6–2.9]), and Charlson Index ≥1 (OR 1.4 [1.0–1.8]) were associated with adherence. “Adenoma” on the EMR problem list remained significant in multivariable analyses (aOR 1.8 [1.3–2.5]). A significant interaction was observed between ethnicity/language and PCP visits (p=.003). Conclusion. Many adenoma-bearing patients fail to attend surveillance colonoscopy in a safety-net setting. Adding “adenomas” to the EMR problem list improved attendance, suggesting that system-level interventions can increase adherence.