Direct Access to Colonoscopy Improves Screening Rates, Adenoma Detection

San Francisco, CA—A Direct Access Screening Colonoscopy (DASC) program at Advocate Illinois Masonic Medical Center in Chicago was found to increase the overall screening rate for colorectal cancer (CRC) by almost 100% without excess complications.

The program is run by a nurse navigator, who questions patients over the telephone to determine patient eligibility for the program and provides instructions for bowel preparations, said Gabriel Rodriguez, MD, resident, Advocate Illinois Masonic Medical Center, at the 2017 Gastrointestinal Cancers Symposium.

CRC is a highly preventable disease if detected early. Despite efforts to inform the public about the clear benefit of CRC screening, the majority of the population does not undergo this procedure. Nearly 60% of patients aged >50 years report never receiving any form of CRC screening, said Dr Rodriguez.

Barriers to obtaining a screening colonoscopy include lack of access to a gastroenterologist, patient anxiety, and lack of knowledge about the procedure. Direct access screening allows certain patients deemed to be in stable health to arrange for a colonoscopy without first having an office consultation with a gastroenterologist.

“We have a couple of gastroenterologists and colorectal surgeons in the hospital who are doing this, so as soon as the patient has a referral, the nurse calls the patient and schedules an appointment for a colonoscopy in less than 2 weeks, and then 1 to 2 days before the procedure, will call the patient back. We also have a couple of nurses who speak different languages, so we have quality communication between the patient and nurse,” said Dr Rodriguez.

During the call prior to colonoscopy, the nurse addresses any questions, and goes over instructions and bowel preparations with the patients.

The DASC program was launched in July 2015. Dr Rodriguez presented data from a retrospective review of all patients who underwent screening colonoscopy from July 2015 to July 2016. Patients not eligible for the program were navigated to a gastroenterologist for a formal evaluation.

A total of 644 patients were referred, of which 373 (58%) were eligible for the DASC program. At the time of data analysis, 289 patients had completed their colonoscopy. Of these, 201 (70%) had a normal colonoscopy and 88 were found to have ≥1 adenomas. One patient was diagnosed with advanced adenoma and 5 were diagnosed with CRC.

Bowel preparation improved from 75% to 95.27% after the DASC program was initiated. The 30% adenoma detection rate was higher than the 20% reported nationally by the American Society for Gastrointestinal Endoscopy.

Among patients aged 50 to 65 years at Advocate Physician Partners, the overall CRC screening rate increased from 30% in January 2015 to 59% in January 2016. Among patients aged ≥65 years, this rate improved from 44% to 69% over the same period.

No patients experienced complications following DASC. Patient satisfaction rates were 96.5% among participants in the DASC program, compared with 93.8% among those screened conventionally.

Dr Rodriguez concluded that DASC “is a safe and effective alternative to the conventional process of obtaining a colonoscopy and can positively impact patient satisfaction and outcomes.”