Purpose: All colon cancer screening using sigmoidoscopy is scheduled using an open access approach at our institution, whereby patients are scheduled directly for the procedure without a prior clinic visit. We sought to determine whether an open access system resulted in appropriate consultation requests for colon cancer screening. Methods: All written Gastroenterology consultation requests specifically asking for colon cancer screening were prospectively identified and tracked. The requests were compared against the A/S/G/E guidelines to determine whether they were appropriate; asymptomatic patients without a family history of colon cancer were directly scheduled for screening sigmoidoscopy without a preprocedure clinic visit. A brief history and a review of the medical records concentrating on the presence of symptoms and family history of colon cancer were conducted when the patient presented for the procedure. Results: A total of 59 out of 348 (17%) consultation requests received during a 3 month period specifically addressed colon cancer screening. 55 of 59 (93%) requested sigmoidoscopy for screening and 4 did not specify the modality to be used; there was no request for screening colonoscopy. The indications for screening sigmoidoscopy was inappropriate in 17 of 59 (29%) cases, because of family history of colon cancer (1) or bleeding (9) or other symptoms (6). 9 of 41 (12%) requests from Internal Medicine, 4 of 5 (80%) requests from Family Practice, and 3 of 8 (38%) requests from Internal Medicine subspecialty clinics were inappropriate. No patient was found to be symptomatic or have family history of colon cancer during the preprocedure interview. Conclusions: Twenty nine percent of consultation requests for colon cancer screening are inappropriate because the patients are symptomatic or have family history of colon cancer. Consultation requests received from the Family Practice clinic were more likely to be inappropriate compared to those received from the Internal Medicine Sub specialties or the Internal Medicine clinics. These results suggest that consultation requests for colon cancer screening require censoring in a substantial portion of cases.
|Original language||English (US)|
|State||Published - 1998|
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