Factors Contributing to Patient Nonattendance at Open-access Endoscopy

Abstract

Patients who miss endoscopy appointments cause inefficient utilization of medical resources. Because national nonattendance rates are as high as 27% and reasons for nonattendance have not been well studied, we sought to quantitate nonattendance at our tertiary care institution. We conducted a retrospective records review of the institutional database to identify patients who did not attend a scheduled endoscopy appointment between January 2000 and December 2003. Nonattendance was defined as either not showing up for an appointment or canceling it on the day it was scheduled. At our institution, patient care assistants contact such patients to document their reasons in the database. Of 36,480 patients scheduled for outpatient endoscopy, 1,490 (4.1%) did not show up because of either facility-related (44.3%; e.g., scheduling errors) or patient-related (55.7%; e.g., noncancellation, illness, or hospitalization) reasons. Our 4.1% nonattendance rate over 4 years is considerably lower than that reported by other endoscopy centers.

Patient Non-adherence and Cancellations Are Higher for Screening Colonoscopy Compared with Surveillance Colonoscopy

“…This is a somewhat lower rate of non-adherence than prior studies, which have reported non-adherence rates ranging from 20 to 42.4 % [5][6][7][8][9][10]. Reasons for the observed non-adherence variation from previous investigations include the heterogeneous evaluation of various types of endoscopic procedures and their indication used in prior studies [5][6][7][8][9][10]14]. Furthermore, adherence in our study was likely higher because we sought to define adherence based on patients already scheduled for their procedure.…”

“…First, our cohort is a diverse multiethnic and racial urban demographic from a single center, making generalizability uncertain. Also, it does not address a number of potential factors that may impact adherence such as cognitive-emotional factors, logistical obstacles, and health system barriers [9,10,15]. Furthermore, because the overall adherence of this cohort was relatively good, the ability to assess many risk factors associated with non-adherence may be limited by the small number of patients who were non-adherent.…”

“…Studies have demonstrated rates of non-adherence to colonoscopy ranging from 20 to 42.4 %, suggesting this may be a barrier to screening for CRC [5][6][7][8][9][10]. Interventions such as patient education with patient navigators and physician communication training, however, can improve adherence to CRC screening [11][12][13].…”

“…Defining the subset of screening and surveillance patients at higher risk for non-adherence could focus services such as navigation programs more efficiently to increase colonoscopy adherence. Prior studies have examined adherence to colonoscopy in the setting of adherence to various endoscopic procedures in addition to colonoscopy [5][6][7][8][9][10]14]. In addition, these studies have taken place in mixed patient populations undergoing colonoscopy for various indications beyond screening and surveillance programs [5][6][7][8][9][10]14].…”

“…The relative risk for non-adherence was 5.42 [95 % confidence interval (CI) 2.74- 10.75] in patients undergoing colonoscopy for screening compared to those for surveillance (16.7 vs. 3.5 % non-adherence, respectively, P \ 0.001). An indication of screening in comparison with surveillance was associated with non-adherence [odds ratio (OR) 12.69, 95 % CI 4.18-38.51] and multiple cancellations (OR 2.33, 95 % CI 1.27-4.31) by multiple regression analysis.…”