Impact of telemedicine on colonoscopy education among veterans.

Abstract

276 Background: The VA Loma Linda Healthcare System (LLVA) offers an in-person colonoscopy education class (IPCC) and a telehealth based education class to patients living closer to outlying VA designated Community Based Outpatient Clinics (CBOCs). 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 IPCC on class attendance rates, colonoscopy attendance and quality measures of colonoscopy. Methods: We reviewed records of 1429 LLVA and CBOC patients referred for colonoscopy class from April 2014 to April 2015. 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 compliance with the first scheduled appointment. We examined 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 difference in attendance to colonoscopy (p = 0.50). Patients receiving primary care at CBOCs more likely chose TBCC; patients receiving primary care at LLVA more likely chose IPCC (92.53% vs 24.77%, p < 0.0001). African Americans and Hispanics more likely chose IPCC; Whites more likely chose TBCC (p = .01). Patients with family history of colorectal cancer or bright red blood per rectum 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 groups (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. Conclusions: A TBCC program can increase 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.