Telemedicine - an innovative health service to improve access to cancer screening

“Provision of services to a patient is more comfortable, improved and simplified,” says Tea Martiashvili, a family doctor at the polyclinic “Medcapital” in Gldani district of Tbilisi, while commenting on the telemedicine service, through which, for several months now, women living in different regions of Georgia have been able to register for cervical, breast and thyroid cancer screening, at a time and place convenient for them, with the help of their family doctors.

“When patients visit their family doctors, of course, they are offered to register for screening, which is a very simple and comfortable procedure, and patients are able to choose the time convenient for them right in the doctor’s office; and they themselves are very satisfied as they no longer have to call [the National Screening Centre] and can plan the procedure while visiting their family doctor.”

Tea Martiashvili. Photo: Dina Oganova/UNFPA

The cervical cancer screening programme was launched in Georgia in 2009, with the technical assistance of the United Nations Population Fund (UNFPA). In order to reduce the cancer death rate, at least 70% of the population should be screened.

Therefore, the United Nations Population Fund (UNFPA), in cooperation with different UN agencies and with the support of the European Union, promotes the development of digital medicine in Georgia to make screening programmes even more accessible to women living in different regions. This is the goal of the joint programme “Minimizing the impact of the COVID-19 outbreak in Georgia through telemedicine and digital health solutions”.

According to UNFPA Programme Officer Lela Shengelia, electronic queue management solution for cervical cancer screening is an important step towards the “digitalization” of healthcare services in Georgia.

“The project permits timely involvement of the target group in the screening programme, early detection of the disease and performance of appropriate interventions. It is important to note that family doctors are actively involved in the implementation of the project, ensuring the referral of at-risk patients for screening and planning follow-up interventions based on the screening results,” she says.

Telemedicine involves the use of modern digital communication technologies to provide quality medical services, which is both time and cost effective for patients.

“Last week I had a patient with a real problem with her breast and she wouldn't go [to the screening centre]. I literally made her to, I registered her, she received a reminder text message, and I was very happy when I learned that two days later, she went to screening. I know for sure that otherwise she wouldn't have gone to get a mammogram... I am also registered and I do screening tests. What really works is that you should be like a role model for your patients,” says Tea Martiashvili, family doctor.

As she notes, registration of patient through the telemedicine service allows her to have complete health records of her patients:

“When I refer my patients for screening, I am also responsible for their health. Some patients would do screening and then would never visit their family doctor. They go [to screening programmes] just for the sake of it. But when I refer them for screening, they will definitely come back to show me the screening test results. This is how a chain of prevention is formed.”

Who should be screened for cancer?

Screening is a medical examination of healthy population to identify health issues that need to be addressed; screening is performed in two cases: when the patient does not have symptoms of a disease and undergoes a planned preventive examination, and in the presence of symptoms, when in-depth diagnostic tests are required.

“Oncological diseases represent a serious challenge for healthcare system in Georgia as well as healthcare systems throughout the world. Therefore, preventive measures, which, along with a healthy lifestyle, include detection of a cancer at the earliest possible stage and provision of the appropriate treatment when it is most effective, are of great importance for the prevention of the development of advanced cancer,” says Eter Kiguradze, Director of the National Screening Centre.

Eter Kiguradze. Photo: Dina Oganova/UNFPA

According to Kiguradze, “the reason for the high death rate and low survival rate among cancer patients is the fact that more than 50% of all cancer cases are diagnosed at stages 3 and 4. And that is why it is utterly important to have well-organized screening programmes in the country that will ensure a reduction in the total cancer morbidity and mortality rates through early detection.” 

“It is also important that when the decease is detected at an early stage the treatment is much more effective, efficient, as well as cost-effective, as this reduces both out-of-pocket expenses and public expenses. Although for a screening programme to achieve its goal - to reduce morbidity and mortality rates through early detection, according to international guidelines, it is necessary to involve at least 60-70% of the target population in the screening programme, that is, the coverage rate of the target population should be at least 60-70%,” she says.

Despite the increase in referrals to screening programmes, the rate is still lower in Georgia. In order to achieve the goal, Eter Kighuradze sees the need for involvement of the primary health care, which is facilitated by the telemedicine programme:

“Although we routinely provide information to the population, it is still important to provide them with more information about the benefits of cancer screening, to facilitate access to screening, notify them about and invite them to screening programmes, which is what organized screening means. The involvement of the primary health care in this process is the most important, as family doctors and village doctors are the ones who can refer the patients to screening centres and ensure that patients attend all screening rounds.”

Every referral is another life saved

At this stage, within the framework of the telemedicine programme, a pilot project is being implemented in three primary health care facilities in Tbilisi. In the March-June reporting period, a total of 9,936 women were registered for cancer screening, of which 19% of the registrations were made directly by citizens (1,846 women), 30% (3,005 women) were registered by primary health care providers, and the remaining 51% (5,085 women) - by health facilities involved in the screening programme;

“We have to consider that every [timely referred] patient is another life saved. Overtime, the reach of the campaign will be expanded, more family doctors will be involved, and the number of referrals will increase,” says Eter Kighuradze, who believes that the remote delivery of healthcare services plays an important role in this process.

As she hopes “in the future the number of referrals will increase and this will eventually lead to full coverage and reductions in cancer morbidity and mortality rates through the screening programme.”

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The telemedicine project in Georgia is jointly implemented by the World Health Organization (WHO), the United Nations Population Fund (UNFPA), the United Nations Children's Fund (UNICEF) and the United Nations Office for Project Services (UNOPS), in cooperation with the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia and with the financial support of the European Union.

The Government of Georgia has already provided 50 rural outpatient clinics with telemedicine equipment. With the support of four organizations of the European Union and the United Nations - the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA) and the United Nations Office for Project Services (UNOPS), another 200 clinics will be able to provide higher quality services to the population.