Tu1433 Comparison of Colonoscopy Follow Up Methods for Patients With Adenomatous Polyps

There is limited date on the effectiveness of follow up systems for patients found to have adenomatous polyps on screening colonoscopy. To determine colonoscopy follow-up for patients with adenomatous polyps and assess the effect of patient directed pre-colonoscopy reminder letters on improving colonoscopy follow up adherence in an open access system. We reviewed and compared two hospital colonoscopy follow up systems. All of the patients were drawn from the same screening population. One system did not send reminder letters to patients needing follow up colonoscopies, however, the gastroenterologists' follow up recommendation was within the patients' Electronic Medical Record (EMR) and sent to the referring physicians. The second system sent 2 reminder letters (±patient call) to the patients 2-3 weeks prior to the recommended follow up colonoscopy in addition to the EMR Gastroenterologist documented recommended follow up. We reviewed all colonoscopies completed from the period of January 2003 to June 2004 to ensure there was adequate time for 3 and 5 year follow-up. A total of 10,193 colonoscopies were reviewed and 1365 patients with adenomatous polyps were identified. Follow up with respect to the 2008 ASGE colorectal screening guidelines, as well as with respect to the physician recommendations were compared. Timely follow up was defined as +/−365 days from the recommended follow up date. Follow up prior to 365 days from recommended date was defined as early. Follow up after 365 days from the recommended date was defined as late. 67% of the patients had a follow up colonoscopy completed with the reminder letter system compared to 63% without reminder letters (P=NS). The system with reminder letters had a higher number of patients with appropriate guideline follow up (38% vs 27%, P<0.01). Additionally, more patients with reminder letters had on time follow up according to the endoscopists' recommendation (43% vs 35%, P<0.01). There were more patients without reminder letters with late follow up according to both the ASGE guidelines (9% vs 2%, P<0.01) as well as compared to the endoscopists' recommendation (12% vs 2.7%, P<0.01). 1. Only two-thirds of patients return for a follow-up colonoscopy after having adenomatous polyps with or without a follow-up colonoscopy reminder. 2. Patient reminder letters, sent prior to recommended follow up colonoscopies, significantly increases the on time follow up according to both the ASGE guidelines as well as the endoscopists' recommendations.