The efficacy of telecolposcopy compared with traditional colposcopy.

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 kappa 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% (kappa = 0.31) for local colposcopists, 52.7% (kappa = 0.22) for site experts, 55.7% (kappa = 0.27) for distant experts who concurrently viewed the examination, and 49.7% (kappa = 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.

Qualitative assessment of telemedicine network and computer-based telecolposcopy.

OBJECTIVE: To qualitatively assess telemedicine network and computer-based telecolposcopy. MATERIALS AND METHODS: A site expert and local colposcopist examined women presenting consecutively for colposcopic examination at 1 of 2 rural clinics. Images from the exam were transmitted to distant experts at a telemedicine center by an existing telemedicine network and computer-based telecolposcopy system. Colposcopists rated both systems with respect to complications, ease and confidence of procedure, and system resolution and visualization. RESULTS: Rates of technically defective examinations were similar for network (25.1%) and computer-based (22.5%) telecolposcopy (p =.46). The ease of telecolposcopic examinations and colposcopists' confidence in and comfort with telecolposcopy were practically equal for both systems. Mean perceived quality of care was greater for network (3.92) compared with computer-based (3.82) telecolposcopy (Wilcoxon signed rank test, p =.03; Likert scale, 1 = minimal, 5 = maximum). Image resolution was rated better for computer-based (3.36) compared with network (3.07, p <.0001) telecolposcopy. However, visualization was better for the latter system in comparison (3.43 vs 3.07, p <.0001). CONCLUSIONS: The quality of telecolposcopy was considered above average based on all parameters evaluated for each type of telecolposcopy. Although a few significant differences were detected, colposcopists perceived network and computer-based telecolposcopy to be very similar by subjective assessment.