Racial/Ethnic Minorities Ineligible for Direct Access Colonoscopy (DAC): Identifying Patients Who Fall Through the Cracks

• Published in: Journal of racial and ethnic health disparities 2015-03, Vol.2 (1), p.86-92
• Main Authors: Miller, Sarah J., Sly, Jamilia R., Itzkowitz, Steven H., Jandorf, Lina
• Format: Article
• Language: English
• Subjects: Access; Adherence; Age; Aged; Aged, 80 and over; Black or African American - statistics & numerical data; Cancer; Chart reviews; Colon; Colonoscopy; Colonoscopy - statistics & numerical data; Colorectal Neoplasms - ethnology; Colorectal Neoplasms - prevention & control; Decision analysis; Demographics; Eligibility Determination - statistics & numerical data; Epidemiology; Ethnic groups; Ethnicity; Ethnicity - statistics & numerical data; Family medical history; Female; Gastroenterology; Gastroenterology - statistics & numerical data; Health care; Healthcare Disparities - ethnology; Hispanic or Latino - statistics & numerical data; Humans; Male; Medicaid; Medical referrals; Medical screening; Medicine; Medicine & Public Health; Middle Aged; Minority & ethnic groups; Minority groups; Minority Groups - statistics & numerical data; Multiple regression analysis; Patient Compliance - ethnology; Patient Compliance - statistics & numerical data; Patients; Primary care; Psychological aspects; Psychological factors; Quality of Life Research; Questionnaires; Race; Racial Groups - statistics & numerical data; Referral and Consultation - statistics & numerical data; Self-efficacy; Social Inequality; Social Structure; Vulnerability
• ISSN: 2197-3792; 2196-8837
• DOI: 10.1007/s40615-014-0051-1

Objective Patients ineligible for direct access colonoscopy (DAC) are typically referred for a pre-colonoscopy consultation with gastroenterology (GI). However, the referral from primary care to GI creates the potential for patients to drop out of treatment. The primary objective of the current study was to examine the proportion of participants deemed ineligible for DAC that (1) attended an appointment with GI and (2) completed a screening colonoscopy. The second aim of the study was to examine predictors of screening colonoscopy adherence. Methods Participants ( N  = 144) were average-risk patients who received a primary care referral for a screening colonoscopy and were deemed ineligible for DAC between 2008 and 2012. Following the primary care visit, participants completed a questionnaire that assessed demographics and psychological factors. Medical chart review determined whether participants completed the screening colonoscopy via the GI referral. Results Of the 144 participants, only 19 (13 %) completed the screening colonoscopy via the GI referral. Multiple regression analyses revealed that decisional balance was the only unique predictor of screening colonoscopy adherence. Conclusions Patients deemed ineligible for DAC are highly unlikely to complete a screening colonoscopy. Interventions are needed to increase screening colonoscopy adherence in this vulnerable population.