Patient interventions are necessary to achieve higher rates of colorectal cancer screening in low-income and minority patients, according to two studies in the current issue of Clinical Gastroenterology and Hepatology, the official journal of the American Gastroenterological Association (AGA) Institute.
Colonoscopy Completion in a Large Safety Net Health Care System
The first study examined patient attendance for scheduled colonoscopies at a large safety net health care system, Denver Health Medical Center. The Denver research team conducted a six-month retrospective review of outpatient endoscopy laboratory scheduling and procedure logs at the center and concluded that 41.7 percent of 817 scheduled outpatient colonoscopies were not attended by patients. Additionally, of those who came for their appointments, 30.2 percent exhibited inadequate bowel preparation.
“Our findings show that there is an enormous problem with patients in safety net health systems skipping their scheduled colonoscopies or showing up inadequately prepared, and anecdotal evidence tells us that the issue is prevalent in safety net systems across the country,” said Thomas D. Denberg, MD, PhD, of the University of Colorado Denver School of Medicine.
This is the first study to formally characterize rates of colonoscopy within a safety net health system. These systems traditionally have a large proportion of low-income and minority patients and report that their colonoscopy no-show rates are “very high.” The Denver research team indicated that the colonoscopy non-attendance rate at Denver Health is much greater than has been described for patients in non-safety-net systems in the U.S., but is comparable to other institutions that serve large numbers of low-income and minority patients.
“The big question now is how to address this issue. Because the rationale and required steps for completing colonoscopy are complex, individual intervention with patient navigators – non-clinical individuals who are specially trained to navigate the health care system – may be particularly helpful. Published accounts show that they have been very successful in minority community health centers and public hospitals in the U.S.,” Dr. Denberg concluded.
A Program to Enhance Completion of Screening Colonoscopy Among Urban Minorities
Specifically examining the role patient intervention plays in completed colonoscopy rates in urban minorities, a research team from Mount Sinai School of Medicine, New York and the City University of New York evaluated the effects of introducing patient navigators in working with urban minorities to complete colonoscopy appointments. The team provided a patient navigator to 532 colonoscopy patients to help guide them through preparation for the procedure and encourage attendance after the primary care physician recommended the procedure.