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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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