In rural Arkansas, an abnormal Pap smear can leave a woman weighing her options, with colposcopic assessment oftentimes hundreds of miles from her reach.  Between 1999 and 2003, Arkansas averaged 148 cases of invasive cervical cancer and 52 deaths annually, ranking 4^th in the nation in cervical cancer mortality. While colposcopy access is largely unavailable in Arkansas’ widespread rural areas, Arkansas’ women also suffer from a healthcare system unsupportive of colposcopy.  In the sixth poorest state in the nation, Arkansas Medicaid does not cover colposcopic exams and only provides reimbursement and treatment for women with colposcopic biopsies showing moderate dysplasia or worse.  Developed and directed by a small team of Advanced Practice Nurses in Arkansas, an innovative telemedicine pilot program delivers colposcopic assessment within a rural Arkansas rural community in response to these alarming needs.

As part of the Antenatal & Neonatal Guidelines, Education and Learning System (ANGELS) program of the University of Arkansas for Medical Sciences, a small outfit of rural and urban APNs pioneered a telecolposcopy clinic combining the expertise of local and remote specialists to predict moderate to severe dysplasia, while administering telemedicine-based monitoring and follow-up for women with less severe conditions.  An APN at a rural Arkansas county health unit performs colposcopic exams using a telemedicine colposcope broadcasting real-time images of the cervix to an ANGELS’ women’s health APN. Through interactive telemedicine, these experts visually assess the cervix to identify the existence and severity of dysplasia to merit biopsy.  This innovative program seeks to determine the sensitivity of telecolposcopy in identifying severity of dysplasia to help build a better system in securing Medicaid reimbursement for Arkansas’ rural women.

By reviewing the cervix through telemedical scope, nurses at UAMS have had success in positively identifying moderate to severe dysplasia requiring biopsy.  Among 201 women receiving telecolposcopy and biopsy, the visual assessment agreed with the biopsy result in 153.  Among the cases where there was disagreement, 33 women were initially suspected to have moderate to severe dysplasia, but biopsy determined this impression was overestimated; whereas, 15 women were underestimated in their severity. 

Telemedicine can achieve an accurate, sensitive assessment of colposcopies comparable to traditional colposcopic exams through simple interactive imaging, which serves as an essential intervention for Arkansas’ rural women facing Medicaid reimbursement restrictions.  When combined with women’s health nursing expertise, telecolposcopy can help assess severity, guide biopsy, and provide follow-up in rural communities without access to specialty care.