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 elsewhere in the state – and the mortality rate for women stricken with these treatable diseases in the three counties alone is more than 30 percent higher than it is elsewhere in the state.
But why? University of Virginia nursing professor Audrey Snyder – one of the medical coordinators of the annual Remote Area Medical Clinic that offers basic care to thousands of individuals in southwest Virginia each July – said the reasons are myriad. A lack of specialty professionals, cumbersome distances 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, Snyder said, should never determine one’s ability to survive an extremely preventable disease. Much of the problem, she explained, comes down to screening. For whatever reason a woman opts out of treatment or receives inferior care, a concerted effort to make screening and follow-up easier and more convenient is prudent.
To that end, Snyder has collaborated with the U.Va. Health System’s Office of Telemedicine, Health System specialists and the health departments in the Lenowisco Health District of far Southwest Virginia to offer real-time exams and consultations for female patients who’ve had concerning results from routine Pap smears that require specialized follow-up.
Snyder’s pilot changes these patients’ early trajectory. After being contacted about their abnormal results, the patients go to a regional health department – the test site is in Wise County – to receive follow-up care. The 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 – performed by trained nurse practitioners and observed in detail and real time by U.Va. physicians and specialists in Charlottesville.
Before and after the exams, U.Va. gynecological oncologist Dr. Peyton Taylor consults with patients just as he would in an office – but via a video screen from several hundred miles away – to answer their questions and allay their concerns.
The set-up allows rural women to have access to the cutting-edge care that the U.Va. Health System offers in Charlottesville, but without the drive time and expense of the commute. The Southwest Virginia nurse practitioners receive specialized training and supervision in conducting colposcopies, the cutting-edge standard of care for those with abnormal Pap results.
Snyder, whose research interest centers around ways to improve health care access, is evaluating this latest effort to determine the feasibility of expanding it to additional health departments and other nurse practitioner 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.
“If we can put into place a variety of methods of screening and follow-up, it can only do good,” Snyder said, “because everyone stricken with this disease deserves a chance at survival. We just have to put the right procedures and technology in place to go the distance”