Govert Veldhuijzen

117 CBE before colonoscopy is reducing operational costs, with lower patient and societal expense INTRODUCTION The diagnostic accuracy of colonoscopy is reliant on the quality of bowel preparation, which is linked to the patient’s compliance with the preparation instructions. Optimizing patient education prior to colonoscopy improves adherence to these instructions and leads to cleaner colons. 1-3 In recent decades, nurses from endoscopy units were tasked with patient education and obtaining informed consent. Better prepared patients have increased the efficiency of the endoscopy unit as proper education reduces the rate of examination failures. 4,5 It is reasonable to expect that by improving patient understanding, compliance, and readiness to consent, patient education programs improve quality of care. Patient education has numerous other benefits, such as increased patient satisfaction, cooperation, and decreased anxiety. 2 However, this comes at a considerable investment to endoscopy units as education programs drain endoscopy nurses who otherwise would facilitate primary endoscopy services. The costs of patient education for the endoscopy department are dependent on the modality of patient education used. Patient navigators e.g. nurse counselling is an effective but very expensive type of patient education programs. As employment of nurses is an important cost-driver, employers are seeking for alternative services that deliver comparable patients education quality, but at lower cost. In literature however, the plethora of publications on improved patient education programs only seldomly evaluate the associated costs. 6-11 In most health care environments the standard-of care for endoscopic patient education consists of face-to-face nurse counselling visits at the outpatients clinic. 12 Several stakeholders are still requesting face-to-face contacts. For instance, the Dutch nationwide colorectal screening program, accounting for approximately one quarter of all colonoscopies in the Netherlands, demands such a pre-colonoscopy outpatients clinic visit. 13-15 These visits have several cost-elements specific for the healthcare provider: providing outpatients consulting rooms, (auxiliary) staff for handling appointments and most costly the wages of the nurse who offers the consultation. This has spurred eHealth initiatives that use computer based education (CBE). 12 Not only hospital costs are important to full economic evaluation of any healthcare intervention. The importance of mandatory out of pocket costs for patients is well known by clinicians as a barrier for undergoing treatments. 16 The main contributing factor in patient education before colonoscopy are travel costs for outpatient clinic visits. Third, there is the societal perspective. An important burden of disease to society is the loss of productivity. 17 Patients (or ‘clients’ in case of screening colonoscopies) have to report short absence leave which creates considerable loss of productivity. 18 6