TY - JOUR
T1 - The efficacy of telecolposcopy compared with traditional colposcopy
AU - Ferris, Daron G.
AU - Macfee, Michael S.
AU - Miller, Jill A.
AU - Litaker, Mark S.
AU - Crawley, Debra
AU - Watson, Diane
N1 - Funding Information:
Supported by a grant (R01 HS08814) from the Agency for Health Care Policy and Research, and the National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
PY - 2002
Y1 - 2002
N2 - OBJECTIVE: Rural women have increased rates of cervical neoplasia, but colposcopic services are limited in rural clinics. The purpose of this study was to estimate the efficacy of telecolposcopy for women in rural health care sites. METHODS: Women with an indication for colposcopy were examined by local colposcopists at one of two rural clinics. Images of the colposcopic examination were transmitted to a tertiary care center for interpretation by an expert colposcopist. Another colposcopist (site expert) in attendance at the rural site also examined the same subjects, but did not share findings with the other colposcopists. Colposcopists independently determined the adequacy of the examination, colposcopic impression, biopsy intent and site, and management. Agreement between colposcopic impressions and cervical histology were assessed by using percent agreement, Cohen's κ statistic, and McNemar's test with Bonferroni's adjustment. RESULTS: Teleconsultation was required for 36.2% of colposcopic examinations. A significantly lower percentage of satisfactory colposcopic examinations was noted by the distant colposcopists (60.0%) compared with the other colposcopists (P < .001). Colposcopic impression agreement with histology varied minimally, 59.7% (κ = 0.31) for local colposcopists, 52.7% (κ = 0.22) for site experts, 55.7% (κ = 0.27) for distant experts who concurrently viewed the examination, and 49.7% (κ = 0.16) for distant experts who viewed the examination on videotape at a later time. CONCLUSION: Teleconsultation was used for a substantial number of examinations. Diagnostic accuracy was maintained, but determination of colposcopic examination adequacy may be impaired by telecolposcopy. Telecolposcopy may help reduce barriers to medical access for women in rural areas.
AB - OBJECTIVE: Rural women have increased rates of cervical neoplasia, but colposcopic services are limited in rural clinics. The purpose of this study was to estimate the efficacy of telecolposcopy for women in rural health care sites. METHODS: Women with an indication for colposcopy were examined by local colposcopists at one of two rural clinics. Images of the colposcopic examination were transmitted to a tertiary care center for interpretation by an expert colposcopist. Another colposcopist (site expert) in attendance at the rural site also examined the same subjects, but did not share findings with the other colposcopists. Colposcopists independently determined the adequacy of the examination, colposcopic impression, biopsy intent and site, and management. Agreement between colposcopic impressions and cervical histology were assessed by using percent agreement, Cohen's κ statistic, and McNemar's test with Bonferroni's adjustment. RESULTS: Teleconsultation was required for 36.2% of colposcopic examinations. A significantly lower percentage of satisfactory colposcopic examinations was noted by the distant colposcopists (60.0%) compared with the other colposcopists (P < .001). Colposcopic impression agreement with histology varied minimally, 59.7% (κ = 0.31) for local colposcopists, 52.7% (κ = 0.22) for site experts, 55.7% (κ = 0.27) for distant experts who concurrently viewed the examination, and 49.7% (κ = 0.16) for distant experts who viewed the examination on videotape at a later time. CONCLUSION: Teleconsultation was used for a substantial number of examinations. Diagnostic accuracy was maintained, but determination of colposcopic examination adequacy may be impaired by telecolposcopy. Telecolposcopy may help reduce barriers to medical access for women in rural areas.
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U2 - 10.1016/S0029-7844(01)01671-4
DO - 10.1016/S0029-7844(01)01671-4
M3 - Article
C2 - 11814505
AN - SCOPUS:0036157680
SN - 0029-7844
VL - 99
SP - 248
EP - 254
JO - Obstetrics and gynecology
JF - Obstetrics and gynecology
IS - 2
ER -