Telecolposcopy in a Primary Care Women's Health Clinic

初级保健妇女健康诊所的远程阴道镜检查

• 批准号: 6892886
• 负责人: ANA MARIA LOPEZ
• 金额: $ 27.74万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-06-01 至 2007-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6892886
• 关键词: adolescence (12-20); adult human (21+); biomedical equipment development; cancer prevention; cervix neoplasms; clinical research; cost effectiveness; diagnosis design /evaluation; endoscopy; female; female reproductive system disorder diagnosis; health care personnel; health care professional practice; health care quality; health care service availability; health disparity; health services research tag; human subject; neoplasm /cancer diagnosis; patient oriented research; primary care physician; rural area; rural health; telemedicine; women' s health

DESCRIPTION (provided by applicant): Telemedicine services are rapidly becoming an integral part of many hospitals and rural clinics around the world and are perceived as having great potential for accessing underserved populations. Although the mortality from invasive cervical cancer in the US has declined over 50% during the past 40 years, likely due to aggressive screening programs, the decrease has not been as dramatic among minority populations and rurally located populations. The Arizona- Sonora Binational Commission has identified cervical cancer prevention as a high priority for Hispanic women. Since the majority of patients with frank cervical carcinoma and cervical dysplasia, its precursor lesion, are asymptomatic, Pap smear screening provides the best approach to early detection. Patients with an abnormal Pap smear and no visible lesion on visual cervical inspection are referred to colposcopy. The colposcope is a magnifying instrument that can directly detect dysplastic lesions of the cervix. Once visualized, the lesion can be biopsied and a tissue diagnosis can be made. Telecolposcopy allows for the collection and transmission of digital cervical images via telecommunications technology. Telecolposcopy can be performed live, in "real-time," with direct communication between the colposcopist and the telecolposcopist, or the telecolposcopist can review the images at a later time via store-forward technology. The use of telecolposcopy provides a means for rural women to access this specialized care without being burdened by usual constraints includingtravel, time off from work due to travel and costs due to travel such as arrangements for child and elder care. Pilot data from a university tertiary care colposcopy clinic demonstrate that the efficacy of telecolposcopy is comparable to that of colposcopy. This study will build on the pilotdata by examining the feasibility of telecolposcopy outside of a tertiary care setting. The central hypothesis of this proposal is that telecolposcopy will be as clinically effective as in.person colposcopy in the assessment of the cervix after an abnormal Pap smear. The secondary hypotheses are (a) patients, their providers, and the telecolposcopists will be satisfied with telecolposcopy services and (b) telecolposcopy can be integrated into a primary care women's health clinical practice in a cost effective manner. The proposed study will result in the improved management of cervical lesions for women with decreased access to telecolposcopy services.

描述（由申请人提供）：远程医疗服务正在迅速成为世界各地许多医院和农村诊所的一个组成部分，并被认为具有很大的潜力，可以接触到服务不足的人群。尽管在过去的40年里，美国浸润性宫颈癌的死亡率下降了50%以上，可能是由于积极的筛查计划，但少数民族和农村人口的死亡率下降并不明显。亚利桑那-索诺拉两国委员会已将预防宫颈癌确定为西班牙裔妇女的高度优先事项。由于大多数患有坦率的宫颈癌和宫颈不典型增生（其前驱病变）的患者无症状，因此巴氏涂片筛查提供了早期发现的最佳方法。巴氏涂片检查异常且宫颈目视检查无明显病变的患者应转诊至阴道镜检查。阴道镜是一种放大仪器，可以直接检测子宫颈的发育不良病变。一旦可视化，病变可以进行活检，并可以进行组织诊断。阴道镜检查允许通过电信技术收集和传输数字宫颈图像。阴道镜检查可以通过阴道镜医生和远程阴道镜医生之间的直接通信“实时”进行，或者远程阴道镜医生可以通过存储转发技术在稍后的时间查看图像。远距离阴道镜的使用为农村妇女提供了一种获得这种专门护理的手段，而不必承受通常的限制，包括旅行、因旅行而请假以及因旅行而产生的费用，如儿童和老人护理安排。来自大学三级护理阴道镜诊所的试点数据表明，电子阴道镜的疗效与阴道镜相当。这项研究将建立在试点数据的基础上，通过研究远程阴道镜在三级医疗机构之外的可行性。该建议的中心假设是，在评估异常巴氏涂片后的宫颈时，远程阴道镜将与亲自阴道镜一样有效。次要假设是：（a）患者、其提供者和远程阴道镜医师将对远程阴道镜服务感到满意，（B）远程阴道镜可以以具有成本效益的方式整合到初级保健妇女健康临床实践中。拟议的研究将改善对远程阴道镜服务减少的妇女的宫颈病变的管理。