Improving Patient Compliance With Post-Vasectomy Testing

05-25-2007 | Categories:

Clinical Info

Source: Nivedita Bhatta Dhar, J. Stephen Jones, Amit Bhatt, Denize Babineau (2007) A prospective evaluation of the impact of scheduled follow-up appointments with compliance rates after vasectomy BJU International 99 (5), 1094–1097. doi:10.1111/j.1464-410X.2006.06725.x

Study Parameters

To prospectively determine the impact of scheduled follow-up appointments with compliance rates after vasectomy, 228 consecutive who men had a vasectomy were studied. Of those, 114 were instructed to bring a semen sample to the office and 114 were given a follow-up appointment to submit samples. All men were instructed to submit specimens at 2 months after vasectomy and at 1-month intervals until two consecutive samples were azoospermic. Over the 18 month study, the mean (range) follow-up was 16 (6–24) months.

Results

In the appointment group, 96/114 (84%) of patients complied with instructions to bring the first sample at 2 months, and in the no-appointment group, 74/114 (65%) complied (P = 0.001). In the appointment group, 43/114 (48%) of patients complied with instructions to provide two consecutive azoospermic specimens and in the no-appointment group, 23/114 (20%) complied (P = 0.005). A subgroup analysis of patients who provided a sample at 2 months indicated that, on adjusting for the results of the first test, patients with appointments were 1.17 times more likely to provide additional specimens than patients with no appointments. Adjusting for the type of appointment, patients who had sperm present in the first test were 6.72 times more likely to provide additional specimens than patients who were azoospermic on the first test.

Commentary

That many men post-vasectomy don’t follow-up with a semen sample to assure that the procedure was successful is not surprising, given that significant rates of noncompliance are common for most healthcare processes.

I am, however, surprised to find that simply scheduling a formal appointment results in a significant improvement in compliance, at least with one sample,

On the other hand, the majority of men in both groups failed to have a second confirmatory test, which intuitively seems most likely the result of “the hassle factor.”

The take-home message from this study, in fact, may well be that reducing obstacles to compliance is always a good strategy.

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