Telecolposcopy in a Primary Care Women's Health Clinic

描述（由申请人提供）：远程医疗服务正迅速成为世界各地许多医院和农村诊所的组成部分，并被认为在获得服务不足的人口方面具有巨大潜力。虽然在过去的40年里，美国浸润性宫颈癌的死亡率下降了50%以上，这可能是由于积极的筛查项目，但在少数民族和农村人口中，这种下降并不明显。亚利桑那州-索诺拉两国委员会已经确定宫颈癌的预防是西班牙裔妇女的重中之重。由于大多数患有宫颈显性癌和宫颈发育不良（其前驱病变）的患者无症状，巴氏涂片筛查提供了早期发现的最佳方法。宫颈涂片异常且宫颈目视检查无明显病变的患者需行阴道镜检查。阴道镜是一种可以直接检测宫颈发育不良病变的放大仪器。一旦发现病变，就可以进行活检并做出组织诊断。遥测镜允许通过电信技术收集和传输数字宫颈图像。遥测镜可以通过阴道镜医师和遥测镜医师之间的直接通信进行现场“实时”操作，或者遥测镜医师可以通过存储前向技术在稍后的时间查看图像。远程显微镜的使用为农村妇女提供了一种获得这种专业护理的手段，而不必受到通常的限制，包括旅行、因旅行而休假以及因旅行而产生的费用，如照顾儿童和老人的安排。一所大学三级保健阴道镜诊所的试点数据表明，阴道镜的疗效与阴道镜相当。本研究将建立在试点数据的基础上，通过检查在三级保健设置之外的远程显微镜的可行性。这一建议的中心假设是，远程显微镜将是临床有效的。人阴道镜检查在宫颈涂片异常后的评估。次要假设是(a)患者、其提供者和远程腹腔镜医生将对远程腹腔镜服务感到满意；(b)远程腹腔镜可以以具有成本效益的方式纳入初级保健妇女健康临床实践。拟议的研究将导致改善管理宫颈病变的妇女较少获得远镜检查服务。

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.