Thi Khuc, MD1, Christian Jackson, MD, FACG2, Daniel Chao, MD2
1Loma Linda University Medical Center, Loma Linda, CA; 2VA Loma Linda Healthcare System, Loma Linda, CA
The VA Loma Linda Healthcare System (LLVA) offers an in-person colonoscopy education class (IPCC) and a telehealth based education class to patients who live closer to outlying VA designated Community Based Outpatient Clinics (CBOCs). Anecdotally, we noticed a significant number of cancellations and no-shows for colonoscopy from patients who sought care from CBOCS. We developed a telehealth based colonoscopy class (TBCC) to be given at CBOCs. The primary aim of the study was to determine effectiveness of TBCC compared to the existing IPCC by evaluating class attendance rates, colonoscopy attendance and quality measures of colonoscopy.
We retrospectively reviewed records of 1429 LLVA and CBOC patients referred for colonoscopy class between April 2014 and April 2015. Patients were given the choice of attending IPCC or TBCC. The primary end points were polyp detection rate (PDR), adenomas detection rate (ADR) and adenocarcinoma detection rate (ACDR). Secondary endpoints were attendance to TBCC and IPCC and attendance to colonoscopy. Attendance was defined as the percentage of patients who complied with their first scheduled appointment. We examined the relationship between age, BMI, sex, race, and indication for colonoscopy in the IPCC and TBCC populations.
Results: TBCC attendance rate was higher than IPCC (p=0.001). There was no significant difference in attendance to colonoscopy between TBCC and IPCC (p=0.50). Patients receiving primary care at CBOCs more likely chose TBCC versus patients receiving primary care at LLVA who chose IPCC (92.53% vs. 24.77%, p< 0.0001).
African Americans and Hispanics more likely chose IPCC, while whites more likely chose TBCC (p=.01). Patients with family history of colorectal cancer and bright red blood per rectum as indications for colonoscopy more likely chose IPCC (p=0.004, p=0.008). Sixty eight percent of colonoscopy preparations were noted to be good. There was no difference in the number of good preparations between TBCC and IPCC (94.3% and 96%, p=0.025). ADR was higher in patients who received IPCC (44.55% and 52.17%, p=0.02). There was no significant difference in PDR and ACDR between TBCC and IPCC groups.
A TBCC program is a means of increasing patient attendance to colonoscopy preparation training without negatively affecting quality of colonoscopy preparation. Prospective, randomized studies on differences in adenoma detection and distance from home residence on class and colonoscopy attendance rates is needed.
Citation: Thi Khuc, MD; Christian Jackson, MD, FACG; Daniel Chao, MD. P0242 - TELEHEALTH-BASED COLONOSCOPY EDUCATION MAY BE A VIABLE ALTERNATIVE TO IN-PERSON COLONOSCOPY EDUCATION AMONG VETERANS. Program No. P0242. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.