title: Perceptions of local health care quality in 7 rural communities with telemedicine.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Graduate Medical Education, and Continuing Medical Education at the University of California, Sacramento, CA 85817, USA. thomas.nesbitt@ucdmc.ucdavis.edu
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Nesbitt
authors.forename: James P
authors.initials: JP
authors.lastname: Marcin
authors.forename: Martha M
authors.initials: MM
authors.lastname: Daschbach
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Cole
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002140:California; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012423:Rural Health / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000592:standards*; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000592:standards*; D013997:Time Factors; D014186:Transportation / Q000706:statistics & numerical data