• John F Steiner, Anh P Nguyen, Kelly S Schuster, Glenn Goodrich, Jennifer Barrow, Claudia A Steiner, and Chan Zeng.
• Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA. john.f.steiner@kp.org.
• J Gen Intern Med. 2024 Jan 1; 39 (1): 364436-44.

BackgroundMissed colonoscopy appointments delay screening and treatment for gastrointestinal disorders. Prior nonadherence with other care components may be associated with missed colonoscopy appointments.ObjectiveTo assess variability in prior adherence behaviors and their association with missed colonoscopy appointments.DesignRetrospective cohort study.ParticipantsPatients scheduled for colonoscopy in an integrated healthcare system between January 2016 and December 2018.Main MeasuresPrior adherence behaviors included: any missed outpatient appointment in the previous year; any missed gastroenterology clinic or colonoscopy appointment in the previous 2 years; and not obtaining a bowel preparation kit pre-colonoscopy. Other sociodemographic, clinical, and system characteristics were included in a multivariable model to identify independent associations between prior adherence behaviors and missed colonoscopy appointments.Key ResultsThe median age of the 57,590 participants was 61 years; 52.8% were female and 73.4% were white. Of 77,684 colonoscopy appointments, 3,237 (4.2%) were missed. Individuals who missed colonoscopy appointments were more likely to have missed a previous primary care appointment (62.5% vs. 38.4%), a prior gastroenterology appointment (18.4% vs. 4.7%) or not to have picked up a bowel preparation kit (42.4% vs. 17.2%), all p < 0.001. Correlations between the three adherence measures were weak (phi < 0.26). The rate of missed colonoscopy appointments increased from 1.8/100 among individuals who were adherent with all three prior care components to 24.6/100 among those who were nonadherent with all three care components. All adherence variables remained independently associated with nonadherence with colonoscopy in a multivariable model that included other covariates; adjusted odds ratios (with 95% confidence intervals) were 1.6 (1.5-1.8) for outpatient appointments, 1.9 (1.7-2.1) for gastroenterology appointments, and 3.1 (2.9-3.4) for adherence with bowel preparation kits, respectively.ConclusionsThree prior adherence behaviors were independently associated with missed colonoscopy appointments. Studies to predict adherence should use multiple, complementary measures of prior adherence when available.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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