Nadim Mahmud, MD, MS, MPH1, Sahil Doshi1, Mary Coniglio, MBA1, Michelle Clermont, MD1, Donna Bernard, MSN2, Catherine Reitz, MPH3, Vandana Khungar, MD, MSc1, David A. Asch, MD, MBA3, Shivan J. Mehta, MD, MBA, MSHP3
1Hospital of the University of Pennsylvania, Philadelphia, PA; 2Penn Presbyterian Medical Center, Philadelphia, PA; 3University of Pennsylvania, Philadelphia, PA
Introduction: The colonoscopy preparation process presents many challenges to patients, and open access patients do not benefit from pre-procedure office visits. This results in undue procedure cancellations, no-shows, and poor bowel preparation. We piloted a text message-based navigation program to improve colonoscopy adherence and gain insight into preparation issues.
Methods: In this cohort study, we offered an automated texting program to patients scheduled for outpatient colonoscopy in April 2018 at an urban academic endoscopy center, and compared this group to randomly-selected controls receiving usual care. Those who agreed to participate received a series of nine instructional and reminder messages sent in the week prior to the procedure. Bidirectional texting was allowed and patient questions were answered within 24 hours. Appointment adherence, bowel prep quality, and colonoscopy completion were prospectively recorded, and a survey to evaluate satisfaction, ease of use, and perceived usefulness of the program was administered at the conclusion of the pilot.
Results: Of 23 patients successfully contacted, 21 agreed to participate in the intervention, and an additional 21 were randomly selected as the control arm. There were no significant differences in age, sex, race, comorbidities, or insurance status between arms (table 1). Intervention patients were significantly more likely to adhere to their colonoscopy appointment (90% versus 48% show rate, p=0.008). Among those who showed for colonoscopy, there were no significant differences in prep quality or completeness between arms (table 2). A total 16 of 21 intervention patients responded to automated texts with questions or comments. The most common questions pertained to the timing of bowel prep components and food restrictions on the day before the procedure.Post-pilot surveys completed by 62% indicated high patient satisfaction (100% high/very high), reported ease of use (92% high/very high), and perceived usefulness of the program (95% high/very high).
Discussion: Patients who enrolled in the automated text navigation program had higher colonoscopy completion rates as compared to usual care controls. Despite higher show rate in the intervention group, preparation quality was comparable. The program was well-received and survey responses indicate a high likelihood of behavioral adoption.
Disclosures: Does Not Disclose
Citation: Nadim Mahmud, MD, MS, MPH; Sahil Doshi; Mary Coniglio, MBA; Michelle Clermont, MD; Donna Bernard, MSN; Catherine Reitz, MPH; Vandana Khungar, MD, MSc; David A. Asch, MD, MBA; Shivan J. Mehta, MD, MBA, MSHP. AUTOMATED TEXT MESSAGE NAVIGATION TO IMPROVE PREPARATION QUALITY AND SHOW RATE FOR COLONOSCOPY. Program No. P0114. ACG 2018 Annual Scientific Meeting Abstracts. Philadelphia, Pennsylvania: American College of Gastroenterology.