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Screening Colonoscopies For the Uninsured Janet Samples, APN, MSN, FNP, CGRN. Objectives. Participants will be able to: Identify the characteristics of their local uninsured population over 50 years of age

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Screening Colonoscopies For the Uninsured Janet Samples, APN, MSN, FNP, CGRN


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screening colonoscopies for the uninsured janet samples apn msn fnp cgrn
Screening Colonoscopies

For the Uninsured

Janet Samples, APN, MSN, FNP, CGRN

objectives
Objectives
  • Participants will be able to:
  • Identify the characteristics of their local uninsured population over 50 years of age
  • Arrange primary care screening for those over 50 in most need of a screening colonoscopy
  • Develop a program to approach vendors and ancillary services for their support and services
  • Understand the need to promote the program for volunteer staff, ancillary services and sponsors in order to follow through on any findings
facts versus fiction
Facts versus Fiction
  • Fact: Colorectal Cancer is the number 2 cancer killer in the United States
  • One in every four adults, age 50-64, lack adequate health insurance or does without health insurance.
  • Misconception: uninsured = unemployed
    • In 2005, 14% of 50-64 age group were retired and uninsured, 23% were unemployed
    • Majority of uninsured were self-employed or worked for small employers
      • 26% were self-employed
      • 30% worked for employers with less than 25 employees

AARP Public Policy Institute, May 2007

income of uninsured
Income of Uninsured
  • One in five lived in families with income below federal poverty level (12,830/yr for family of two) in 2005
  • >Two in five had income <16,038 for family of two which is 200% of poverty level
  • An even higher proportion of retirees were below the poverty level, 27% at poverty level, 51% <16,038 for family of two
  • One-third of those 50-64 were above poverty level, but with income less that 20,000

AARP Public Policy Institute, May 2007

out of pocket health expenses
Out-of-Pocket Health Expenses
  • Uninsured, ages 50-64, spend an average of $915 per year
  • This is 2.5 to 4 times higher than for the younger uninsured
  • Income usually increases with age, but can flatten in the decade before age 65 due to disability or early retirement

AARP Public Policy Institute, May 2007

other facts
Other Facts
  • Of the uninsured age 50-64
    • 40% are in very good or excellent health
    • 21% report fair to poor health
  • Versus their insured peers
    • 53% report excellent or very good health
    • 18% report fair or poor health
  • Health spending burden of underinsured
    • Roughly 28% with or without coverage are underinsured which falls highest among the poor or low incomes

AARP Public Policy Institute, May 2007

recession facts
Recession Facts
  • Number of uninsured jumped nearly 3 million in 2009
  • CDC reports in 2009, 46.3 million U.S. adults lacked health insurance.
  • This equals to one in five working age adults. Texas is the worst with 24.6% of population uninsured
  • “In the U.S., health insurance means access to health care” CDC
  • Uninsured are less likely to get preventative care and often delay care until condition is serious.
  • Since 2007 insurance with high deductibles discourage preventative care.

Steven Reinberg, HealthDay News for Healthier Living, June 2010

cdc colorectal cancer control program
CDC Colorectal Cancer Control Program
  • Estimated 142,570 new cases in 2010 with 51,370 deaths from CRC
  • Successful screening results: Now more than 1 million survivors of colorectal cancer in the United States
  • 80 million baby boomers are set to retire and 91% of new CRC cases occur in this age group
  • Program’s goal is to increase screening rates of individuals over 50 through education and screening
  • These are tailored for low-income, uninsured and underinsured individuals aged 50-64
  • AGA supports this program and is requesting that Congress continue to support the CDC’s programming

American Cancer Society, Cancer Facts and Figures 2009

communication barrier
Communication Barrier
  • Survey focused on the uninsured to examine disparities in colorectal cancer screening
  • Results show that the uninsured were 64% less likely to be screened than the insured
  • Provider recommendation was the only significant communication measure.
  • Uninsured lacking a recommendation were 98.5% less likely to be screened than those with a recommendation
getting started
Getting Started
  • Set up your team – you will assign sections of program to each team member
  • Initial team decisions will include:
  • Determine how many colonoscopies you want to perform
  • How many volunteers will be needed
  • Give yourself 2-3 months to set this up
  • Set your dates – one for preps, one for colonoscopy
team assignments
Team Assignments
  • Volunteers: This person will present plan to physicians and employees.
  • Ancillary Services: Anesthesia, pathology, surgeons and hospital.
  • Supplies: Determine needs and sources
  • Patients: Identify and approach the source Primary Care Providers for the uninsured
  • Program: Set up flow of program, promotional items, post-program advertising
volunteers13
Volunteers
  • Set up meeting to present plan and need for volunteers
  • Announce both dates
  • Post sign up sheets for specific tasks to be done
    • Registration and discharge on both dates
    • History, set up charts on prep date
    • Colon prep instructions
    • Dispense prep kit and t-shirts (our plan)
    • Pre-op, post-op staff, follow up call
    • Physician, assistant and anesthesia
ancillary services
Ancillary Services
  • Explain the plan to each one personally
  • Anesthesia: Line up volunteers for each suite being clear about how many patients they will see
  • Pathology: Ask your primary lab to process biopsies at no charge. Work to prevent charges to patient
  • Surgeons: Have a back-up for complications
  • Hospital: Get your hospitals on board to provide services if needed
  • Inform these providers of any advertising or promotional credit they may receive
supplies16
Supplies
  • Take note of all necessary supplies and costs, using daily usage as source
  • Ask pharmaceutical vendors for donated prep kits
  • Ask equipment vendors for donated forceps, snares, etc. or replacement for those used
  • Decide on main sedation and any back up – approach supplier or plan to donate from your supplies
patient source
Patient Source
  • Contact and meet with the PCP’s who provide care to uninsured patients
  • Divide available screenings among them
  • Ask for patients 50 years and older with no symptoms, no previous colonoscopy, keeping this a screening colonoscopy
  • Arrange for advance receipt demographic sheets
  • Provide your required forms to be filled out and brought to first visit
  • Prepare for language and literacy barriers
program promotion
Program Promotion
  • Meet with volunteers to answer questions and set up plan for smooth flow of patients
  • Get sizes and order T-shirts with vendor/donor logos on back and theme on front, as gift to volunteers and patients. Have everyone wear on day of colon. This will increase the bond of all involved
  • Keep communications going among teams
  • Refreshments for patients
give credit
Give Credit
  • Marketing to contact media for coverage on day of colonoscopy, no advertisement prior to this
  • Publish a big thank you to all participants
  • Follow up with a media impact report
  • Challenge others to step up – In April 2010 the Tri-Cities Gastroenterology Group partnered with free clinics for a similar program
our results
Our Results
  • Our goal was to perform 50 screening colonoscopies
  • Each patient received premium care from our staff
  • 48 of the 50 selected patients followed through with the screening
  • Nine physicians performed 48 colonoscopies one Saturday morning into early afternoon
  • 25 of the 48 patients had polyps removed eliminating them as a risk for colorectal cancer