Abstract
Introduction: In addition to having negative consequences on patients' health, appointment nonadherence reduces healthcare efficiency and increases healthcare costs. The issue of nonadherence is even more problematic within the underserved population, where resources are scarce. Identifying factors associated with appointment nonadherence can lead to improved practice efficiency and better patient care outcomes. Methods: We performed a 2-year retrospective review of patients scheduled for outpatient colonoscopy at Maricopa Integrated Health System (MIHS), a large safety-net healthcare system in Phoenix, AZ, to identify and compare characteristics of patients who successfully completed colonoscopy versus those who noshowed, cancelled, or had inadequate bowel prep. Variables analyzed with logistic regression models included demographics, insurance status, prior endoscopy/outpatient appointment adherence, family history, and indications for the procedure. Results: Of the 3672 patients who were scheduled for outpatient colonoscopy and met our inclusion criteria, 1071 patients (29.2%) did not complete their appointment: 458 (12.5%) cancelled, 304 (8.3%) no-showed, and 304 (8.3%) had inadequate bowel prep. Higher appointment completion rates were associated with being married (OR 0.67, P<0.001) or Hispanics who identify Spanish as the preferred language (OR, 0.66; P=0.049). Higher appointment nonadherence rates were associated with patients who indicated they were Hispanic (OR 1.25, P=0.049), smokers (OR 1.24, P=0.016), had prior endoscopy appointment cancellation (OR, 2.32; P<0.001), had prior outpatient visit no-show (OR 1.34, P=0.005), and were scheduled for screening colonoscopy (OR 1.39, P=0.001). Higher appointment no-show rates were associated with patients with Medicaid coverage (OR 1.81, P=0.006), who were smokers (OR 1.63, P=0.001), scheduled for screening colonoscopy (OR 1.69, P=0.001), who had prior endoscopy appointment cancellation (OR 1.12, P=0.001), and had prior outpatient visit no-show (OR 1.75, P<0.001). Conclusion: In our particular underserved population, we have identified several factors that are associated with appointment nonadherence for scheduled outpatient colonoscopy. System-wide plans have been implemented to provide extra education and support to the patients who are at risk. Our goal is to decrease our nonadherence rate to less than 20% by 2019 in order to improve our colon cancer screening and prevention efforts in our population.