Close together, but from a distance

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New pilot procedure screening for gynecologic cancers using tele-medicine brings UVA Medical clinicians and rural Virginians close together for care from hundreds of miles away

It’s long been known that there’s a dearth of access to medical care in general and advanced gynecologic care in particular for women in rural Southwest Virginia. As a result, rates of cervical and uterine cancers are nearly 7 percent higher in Lee, Wise and Scott Counties than they are elsewhere in the state – and the mortality rate for women stricken with these treatable diseases in these three counties alone is more than 30 percent higher than it is elsewhere in the state.

But why? Experts like nursing professor Audrey Snyder -- one of the medical coordinators of the annual Remote Area Medical Clinic which offers basic care to thousands of individuals in southwest Virginia each July -- says the reasons are myriad. A lack of specialty professionals, cumbersome distance to travel for care, lackluster health insurance, and economic hardship all impact rural Virginians’ access to care, as does fear of the outcomes and of experiencing pain.

But one’s geographic location, asserts Snyder, should never determine one’s ability to survive an extremely preventable disease. Much of the problem, she explains, comes down to screening. Whether these women distrust clinicians, don’t have transportation to and from appointments, live at a vast distance from providers or fear the outcome – or some combination of each of these factors – it’s clear that a concerted effort to make screening and follow-up easier and more convenient is prudent.

To that end, Snyder has collaborated with the UVA Health System Office of Telemedicine (David Catell-Gordon), UVA Health System specialists (Dr. Peyton Taylor, gynecologist oncologist) and the health departments in the Lenowisco Health District of far southwestern Virginia to offer real-time exams and consultations for female patients who’ve had concerning results from routine pap smears requiring specialized follow-up. After being contacted about their abnormal results, these patients go to the regional health department – the test site is in Wise County, Va. – to receive follow-up care. These follow-up appointments involve colposcopies – a vaginal scope with a camera at the end to detect cell abnormalities and lesions inside the vagina, cervix and uterus – which are performed by trained nurse practitioners and observed in detail and real time by UVA physicians and specialists located in Charlottesville.

Before and after the exam, Dr. Taylor consults with patients just as he would in an office – but via a TV screen from several hundred miles away – to answer their questions and allay their concerns. The set-up allows rural women to have access to cutting edge care that the UVA Health System offers in Charlottesville but without the drive time and expense of the commute. Nurse practitioners located in rural southwest Virginia receive specialized training and supervision in conducting colposcopies, the most cutting edge standard of care for those with abnormal pap results. Patients, of course, have access to the very best care easily, cost-effectively, and from a distance.

Snyder, who has worked tirelessly to study ways to improve access to healthcare, is evaluating this latest effort with colposcopies and telemedicine to determine feasibility for expansion to additional health departments and other NP clinics in the area, including in Wise and Tazwell Counties. She’s also interviewing women who’ve had the procedure to determine what their short-term outcomes are, aiming ultimately to fully understand how well this effort at collaborative care at a distance serves some of the state’s most vulnerable women. She, David Catell-Gordon and Dr. Taylor not only are delivering on UVA’s mission to offer the best, most compassionate, most collaborative care possible, they’re en route to truly changing the outcomes for hundreds, if not thousands of rural Virginians who might otherwise perish from truly preventable diseases.

“If we can put into place a variety of methods of screening and follow-up, it can only do good,” says Snyder, “because everyone stricken with this disease deserves a chance at survival – we just have to put the right procedures and technology in place.”