Effect of a mailed brochure on appointment-keeping for screening colonoscopy - A randomized trial

Background: Even when primary care physicians have face-to-face discussions with patients before referring them for screening colonoscopy, patient nonadherence can be substantial. Often, primary care physicians lack sufficient time to educate patients and address their potential misconceptions and fears about this procedure. Objective: To test whether an informational brochure sent to patients' home addresses after referral for screening colonoscopy would increase patient completion of the procedure. Design: Randomized, controlled trial. Setting: 2 general internal medicine practices affiliated with the University of Colorado Health Sciences Center. Patients: 781 consecutive patients 50 years of age or older referred by their primary care physicians for screening colonoscopy. Intervention: Patients were randomly assigned to receive usual care (control group) versus usual care plus an informational brochure (intervention group). The brochure was mailed within 10 days of referral for screening colonoscopy; it mentioned the name of the patient's primary care physician and encouraged patients to schedule a procedure. It also described colorectal cancer and polyps and the similar lifetime risks for colorectal cancer for men and women, colonoscopy and risk for perforation, the nature of bowel preparation for the procedure, and alternative screening tests. Measurements: Rates of adherence to screening colonoscopy in the 2 study groups. Results: The overall adherence rate was 11.7 percentage points (95% Cl, 5.1 to 18.4 percentage points) greater in the intervention group than in the control group (70.7% vs. 59.0%). Older patients were more adherent than younger patients. Patients with low-income insurance plans, such as Medicaid, were less adherent despite being sent a brochure. Limitations: The small number of clinical practices and minority patients may limit generalizability. In addition, it was not possible to determine the degree to which adherence was influenced by a reminder to schedule a procedure versus detailed information about colonoscopy. Conclusions: An inexpensive mailed brochure is an effective way to increase patient adherence to primary care physician referral for screening colonoscopy.