Telemedical Cervical Cancer Screening to Bridge Medicaid Service Care Gap for Rural Women

Background: The Arkansas Medicaid program for low-income women provides cervical cancer screening, in the form of Pap smears, and treatment but no diagnostic means of bridging the two, such as a procedure called "colposcopy." Telemedicine offers a viable means to bridging this gap. Previously telecolposcopy has been used in small demonstration projects as a means to deliver colposcopy services to at-risk rural populations at a comparable quality to in-person colposcopy. Subjects and Methods: The University of Arkansas for Medical Sciences' Antenatal & Neonatal Guidelines, Education and Learning System Program and Center for Distance Health developed an innovative collaborative telemedicine pilot program with the Arkansas Department of Health that used both specialty physician oversight and nurse examiners. Underserved rural patients from the Department of Health were provided with colposcopy services via interactive telemedicine at four separate spoke sites. During each weekly 3-h clinic, an advanced practice nurse/nurse practitioner at each of the spoke sites performed the exams and collected biopsy specimens under the real-time, interactive supervision of an experienced faculty member at the hub site. Results: Between January 1, 2010 and June 21, 2011, the program scheduled 1,812 visits, involving 1,504 unduplicated patient referrals from 68 of Arkansas's 75 counties, and performed 1,298 telecolposcopic exams. Conclusions: This project provides complex specialty gynecological services using telemedicine technology to overcome geographic barriers to care while producing results comparable to traditional examinations. It is cost-effective and well received by patients and can be used as a model for improving access to care among vulnerable populations.