Overcoming poor attendance to first scheduled colonoscopy: A randomized trial of peer coach or brochure support

OBJECTIVES: Among patients unlikely to attend a scheduled colonoscopy, we examined the impact of peer coach versus educational brochure support and compared these with concurrent patients who did not receive support. METHODS: From health system data, we identified 275 consecutive patients aged >50 who kept <75% of visits to 4 primary care practices and scheduled for a first colonoscopy from February 1, 2005 to August 31, 2006. Using block randomization, we assigned consenting patients to a phone call by a peer coach trained to address barriers to attendance or to a mailed colonoscopy brochure. Study data came from electronic medical records. Odds ratios of colonoscopy attendance were adjusted for demographic, clinical, and health care factors. RESULTS: Colonoscopy attendance by the peer coach group (N=70) and brochure group (N=66) differed by 11% (68.6% vs 57.6%, respectively). Compared with the brochure group, the peer coach group had over twofold greater adjusted odds ratio (AOR) of attendance (2.14, 95% confidence interval [CI]=0.99-4.63) as did 49 patients who met the prespecified criteria for needing no support (2.68, 95%CI=1.05-6.82) but the AORs did not differ significantly for 41 patients who declined support (0.61, 95%CI=0.25-1.45) and 49 patients who could not be contacted (0.85, 95%CI=0.36-2.02). Attendance was less likely for black versus white race (AOR=0.37, 95%CI=0.19-0.72) but more likely for patients with high versus low primary care visit adherence (AOR=2.30, 95%CI=1.04-5.07). CONCLUSION: For patients who often fail to keep appointments, peer coach support appears to promote colonoscopy attendance more than an educational brochure.