Perceptions of Local Health Care Quality in 7 Rural Communities with Telemedicine

Graduate Medical Education, and Continuing Medical Education at the University of California, Sacramento, CA 85817, USA.
The Journal of Rural Health (Impact Factor: 1.45). 02/2005; 21(1):79-85. DOI: 10.1111/j.1748-0361.2005.tb00066.x
Source: PubMed


Rural health services are difficult to maintain because of low patient volumes, limited numbers of providers, and unfavorable economies of scale. Rural patients may perceive poor quality in local health care, directly impacting the sustainability of local health care services.
This study examines perceptions of local health care quality in 7 rural, underserved communities where telemedicine was implemented. This study also assesses factors associated with travel outside of local communities for health care services.
Community-based pretelemedicine and posttelemedicine random telephone surveys were conducted in 7 northern California rural communities assessing local residents' perceptions of health care quality and the frequency of travel outside their community for health care services. Five-hundred rural residents were interviewed in each of the pretelemedicine and posttelemedicine surveys. Between surveys, telemedicine services were made available in each of the communities.
Residents aware of telemedicine services in their community had a significantly higher opinion of local health care quality (P =.002). Satisfaction with telemedicine was rated high by both rural providers and patients. Residents with lower opinions of local health care quality were more likely to have traveled out of their community for medical care services (P =.014).
The introduction of telemedicine into rural communities is associated with increases in the local communities' perception of local health care quality. Therefore, is it possible that telemedicine may result in a decrease in the desire and need for local patients to travel outside of their community for health care services.

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    • "Telemedicine alleviates some of the issues rural physicians experience, including lack of onsite specialists, isolation, poor communication, and lack of access to current medical information and continuing medical education [2]. Patients’ perception of the quality of care may be improved via telemedicine [5] and financial impact of transfer avoidance may be reduced [6]. Despite these demonstrated and potential benefits, the literature reveals that hospitals and rural physicians have been slow to adopt telemedicine initiatives [7-9]. "
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    ABSTRACT: Background Telemedicine technology can improve care to patients in rural and medically underserved communities yet adoption has been slow. The objective of this study was to study organizational readiness to participate in an academic-community hospital partnership including clinician education and telemedicine outreach focused on sepsis and trauma care in underserved, rural hospitals. Methods This is a multi-method, observational case study. Participants included staff from 4 participating rural South Carolina hospitals. Using a readiness-for-change model, we evaluated 5 general domains and the related factors or topics of organizational context via key informant interviews (n=23) with hospital leadership and staff, compared these to data from hospital staff surveys (n=86) and triangulated data with investigators’ observational reports. Survey items were grouped into 4 categories (based on content and fit with conceptual model) and scored, allowing regression analyses for inferential comparisons to assess factors related to receptivity toward the telemedicine innovation. Results General agreement existed on the need for the intervention and feasibility of implementation. Previous experience with a telemedicine program appeared pivotal to enthusiasm. Perception of need, task demands and resource need explained nearly 50% of variation in receptivity. Little correlation emerged with hospital or ED leadership culture and support. However qualitative data and investigator observations about communication and differing support among disciplines and between staff and leadership could be important to actual implementation. Conclusions A mixed methods approach proved useful in assessing organizational readiness for change in small organizations. Further research on variable operational definitions, potential influential factors, appropriate and feasible methods and valid instruments for such research are needed.
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    • "Our proposed Cybercare system would combine what is best from the old medical system and the new: the family doctor and the central hospital. The family doctor in a local clinic would be empowered with technology that allows him or her to provide an ER-like immediate coordination of care by linking across the network to any specialist and by substituting some in-person visits with on-camera visits [6], [7]. We would still need central hospitals for specialized services like trauma care, transplantation, oncology, and positron emission tomography scanning. "
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    ABSTRACT: Health-care system reforms can change the structure of the current U.S. health-care system, from centralized large hospitals to a distributed, networked healthcare system. In our model, medical care is delivered locally in neighborhoods and individual homes, using computer technologies like telemedicine, to link patients and primary care providers to tertiary medical providers. This decentralization could reduce costs enough to provide all citizens with medical insurance coverage; it would benefit patients and providers; and as a dual-use system, it would better protect the country's resources and citizens in an event of biological terror or natural disasters.
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    ABSTRACT: Telemedicine research addressing user satisfaction abounds in academic literature. Results from patient satisfaction studies indicate exceptionally high levels of perceived satisfaction, often above the rates of expected satisfaction for traditional forms of health delivery. Results from provider satisfaction studies are also generally quite positive; however, data from providers point to higher concerns with delivery barriers and challenges. Even though data from patient and provider satisfaction research suggests overwhelming optimism for this delivery modality, this paper urges cautious embracement of these results for several reasons. First, many of the studies exhibit serious methodological weaknesses related to design and data collection instruments. In addition, the construct of satisfaction is largely undefined and is not clear. Even recognizing these caveats, the results of the study do offer some evidence that patient satisfaction will not impede the deployment of telemedicine, but provider satisfaction merits additional study.
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