S395 A Free Screening and Diagnostic Colonoscopy Program for Uninsured Population Demonstrates Success of Collaborative Efforts to Decrease Disparities Due to Socioeconomic Status

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Introduction: The incidence and mortality of colon/rectal cancer in Ohio is 10% higher than the national average; 67.7% of Ohioans met screening guidelines compared to the national average of 69.3%. Ten point two percent of those under 65 years of age living in Columbus are without health insurance. Screening for colorectal cancer (CRC) is challenging for the uninsured population. We present a program aiming to remove barriers to providing free screening and diagnostic colonoscopies to the uninsured in Columbus, Ohio through partnership between a medical student run free clinic and a tertiary academic medical center. Methods: The program was launched in July of 2022 at a hospital serving primarily the economically disadvantaged population in Columbus. Colonoscopies were conducted quarterly on Saturdays. Patients’ insurance was verified, and they were then screened for appropriateness for moderate sedation by use of questionnaire and gastroenterologist. Up to 18 patients were scheduled for the Saturday session split between two gastroenterologists. Two days before their procedure, the patients had a clinic appointment where appropriateness for procedure was confirmed and free bowel prep and instructions were provided. Virtual interpreter was used for non-English speaking patients. A program manager called patients the day before their colonoscopy to confirm they were prepping and was on-call overnight. Transportation and housing were provided if needed. On day of program, medical students and the program manager checked in patients and helped explain results. Endoscopy staff worked in the endoscopy rooms. A follow-up was arranged for all patients at the free clinic to go over the results. Gastroenterologists reviewed pathology and provided surveillance recommendations. Results: From 2022-2023, 5 free colonoscopy days were held. Ninety-two people underwent a colonoscopy with greater than 60% performed for screening. There was a 100% show-rate and 98% had adequate bowel prep. More than 50% of patients were non-English speaking. One hundred and sixty polyps were removed and no complications occurred. Only 1 cancellation occurred due to asymptomatic bradycardia noted during pre-procedure check in. Conclusion: We show that with collaboration between gastroenterologists, endoscopy leadership, community health workers and a free community clinic, it is possible to overcome barriers and reduce disparities in CRC screening. In the future, we aim to expand the program. We will also look at CRC education as well as identifying other barriers.

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