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An Evidence-based Approach Towards Targeted Patient Education to Improve Bowel Preparation for Colonoscopy

医学 优势比 肠道准备 结肠镜检查 内科学 置信区间 逻辑回归 社会经济地位 病人教育 风险因素 重症监护医学 结直肠癌 家庭医学 人口 环境卫生 癌症
作者
Marguerite Kutyla,Sam O’Connor,Luke F. Hourigan,Bradley J. Kendall,Amanda Whaley,Vera Meeusen,Gerald Holtmann
出处
期刊:Journal of Clinical Gastroenterology [Lippincott Williams & Wilkins]
卷期号:54 (8): 707-713 被引量:8
标识
DOI:10.1097/mcg.0000000000001286
摘要

Goals and Background: Quality of bowel preparation is an important factor influencing adenoma detection. Patient education is believed to improve the quality of bowel preparation but might be resource-intensive. We aimed to (a) identify risk factors for failed bowel preparations and (b) develop and test the efficacy of a screening tool that allows to prospectively identify and target patients at increased risk. Study: Part 1: 76 consecutive outpatients with poor bowel preparation were compared with 76 age-matched and gender-matched outpatients with good preparation from the same procedure lists. Sociodemographic and clinical data were obtained from centralized databases. Univariate analysis and multivariate logistic regression was used to identify risk factors for poor bowel preparation. Part 2: on the basis of results of part 1, a screening tool for prospectively identifying patients at high risk was developed, and targeted education tested. Results: We identified the use of opioids or other constipating agents and low socioeconomic status as risk factors for poor bowel preparation [odds ratio (OR)=2.88; 95% confidence interval (CI): 1.22-6.80 and OR=2.43; 95% CI: 1.25-4.72]. Diabetes, hypothyroidism, age, and gender were found to have no effect on quality. When education was provided only to patients at increased risk, the targeted approach did not negatively affect the proportion of poor preparation (OR=6.12%; 95% CI: 4.79%-7.78% vs. OR=5.73%; 95% CI: 4.61%-7.10%). Conclusions: Poor bowel preparation is associated with specific risk factors. Identifying and specifically targeting education at patients with these risk factors appears to facilitate more efficient use of education resources in endoscopy.
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