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Volume
8: No. 3, May 2011
COMMUNITY CASE STUDY
Collaboration to Increase Colorectal Cancer Screening Among Low-Income Uninsured Patients
The first step is to determine whether the person is
low-income uninsured. If no, then the person is referred through usual
channels via the Referral Coordinator. If yes, then the person�s age
determines the next step.
If the person is aged less than 50 years, then their level of risk is
determined (high risk or intermediate risk). After a FOBT, high-risk people with either a positive or a negative test receive APA referral even without
gastrointestinal symptoms. Intermediate-risk persons with a positive FOBT
receive a referral for a colonoscopy. Intermediate-risk persons with a
negative FOBT are recommended to receive a repeat FOBT in 6 months. If that
test is positive, the person receives a referral for a colonoscopy. If that
test is negative, then the process is ended and the person should consider a
flexible sigmoidoscopy.
If the person is aged 50 years or older, a screening FOBT with a
negative result ends the process and the person should consider a flexible
sigmoidoscopy. If the screening test is positive, the person receives a
referral for a colonoscopy. If the person is at intermediate risk, an FOBT
with either a negative or positive test results in a referral for a
colonoscopy. If the person is at high risk, an FOBT with either a negative
or positive test results in a referral to Anchorage Project Access even if the person has no
gastrointestinal symptoms.
Figure 2. Referral flow chart, Anchorage Neighborhood
Health Center, 2009. Note: FOBT should be performed on all referrals. A negative
test does not necessarily deflect referral when appropriate but is helpful
collateral information. Definitions: intermediate risk, no specific
gastrointestinal symptoms and either family history or weight loss; high-risk, a
person with a history of colon cancer, first degree family history, or change in
stool pattern and rectal bleeding or unexplained weight loss. Abbreviations: FOBT, fecal occult blood test; APA, Anchorage Project Access; RFL, Ride for Life
Alaska
funding; flex sig, flexible
sigmoidoscopy; GI, gastrointestinal; sxs, symptoms.
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