title: Using telemedicine to provide pediatric subspecialty care to children with special health care needs in an underserved rural community.
abstract: OBJECTIVE
  For children with special health care needs (CSHCN) that live in rural, medically underserved communities, obtaining subspecialty care is a challenge. Telemedicine is a means of improving access to these children by addressing rural physician shortages and geographic barriers. This article reports a medical-needs assessment of parents/guardians with CSHCN and the status of a telemedicine program for CSHCN as well as the results of parent/guardian and local provider satisfaction with the telemedicine program.
  
  
  METHODS
  We report the results of a pretelemedicine medical-needs survey conducted in March 1999 by using a convenience sample of CSHCN living in a rural, medically underserved community located 90 miles north of the University of California Davis Children's Hospital (Davis, CA). In April 1999, a telemedicine program was initiated to provide consultations to CSHCN and has continued since. We also report the parent/guardian's perceptions of the appropriateness and quality of telemedicine consultations and the local provider's satisfaction with telemedicine consultations completed from April 1999 to April 2002.
  
  
  RESULTS
  The pretelemedicine medical-needs assessment demonstrated several barriers in access to subspecialty care including traveling >1 hour for appointments (86% of parents/guardians), missing work for appointments (96% of working parents/guardians), and frequently relying on emergency department services and/or self-regulation of their child's medications. From April 1999 to April 2002, 130 telemedicine consultations were completed on 55 CSHCN. Overall, satisfaction was very high. All the parents/guardians rated satisfaction with telemedicine care as either "excellent" or "very good," and all but 2 of the rural providers' surveys reported satisfaction with telemedicine as "excellent" or "very good." The frequency of telemedicine consultations has increased with time.
  
  
  CONCLUSIONS
  Pediatric subspecialty telemedicine consultations can be provided to CSHCN living in a rural, medically underserved community with high satisfaction among local providers and parents/guardians. Telemedicine should be considered as a means of facilitating care to CSHCN that, relative to the customary delivery of health care, is more accessible, family-centered, and coordinated among patients and their health care providers.
authors.affiliation: Department of Pediatrics, University of California, Davis, USA. jpmarcin@ucdavis.edu
authors.forename: James P
authors.initials: JP
authors.lastname: Marcin
authors.forename: Jeff
authors.initials: J
authors.lastname: Ellis
authors.forename: Roland
authors.initials: R
authors.lastname: Mawis
authors.forename: Eule
authors.initials: E
authors.lastname: Nagrampa
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Nesbitt
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Dimand
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002140:California; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D020380:Needs Assessment; D010290:Parents / Q000523:psychology; D019035:Rural Health Services; D017216:Telemedicine / Q000706:statistics & numerical data / Q000639:trends