title: Teleconsultation service to improve healthcare in rural areas: acceptance, organizational impact and appropriateness.
abstract: BACKGROUND
  Nowadays, new organisational strategies should be identified to improve primary care and its link with secondary care in terms of efficacy and timeliness of interventions thus preventing unnecessary hospital accesses and costs saving for the health system. The purpose of this study is to assess the effects of the use of teleconsultation by general practitioners in rural areas.
  
  
  METHODS
  General practitioners were provided with a teleconsultation service from 2006 to 2008 to obtain a second opinion for cardiac, dermatological and diabetic problems. Access, acceptance, organisational impact, effectiveness and economics data were collected. Clinical and access data were systematically entered in a database while acceptance and organisational data were evaluated through ad hoc questionnaires.
  
  
  RESULTS
  There were 957 teleconsultation contacts which resulted in access to health care services for 812 symptomatic patients living in 30 rural communities. Through the teleconsultation service, 48 general practitioners improved the appropriateness of primary care and the integration with secondary care. In fact, the level of concordance between intentions and consultations for cardiac problems was equal to 9%, in 86% of the cases the service entailed a saving of resources and in 5% of the cases, it improved the timeliness. 95% of the GPs considered the overall quality positively. For a future routine use of this service, trust in specialists, duration and workload of teleconsultations and reimbursement should be taken into account.
  
  
  CONCLUSIONS
  Managerial and policy implications emerged mainly related to the support to GPs in the provision of high quality primary care and decision-making processes in promoting similar services.
authors.affiliation: Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milano, Italy. paolo.zanaboni@polimi.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Zanaboni
authors.forename: Simonetta
authors.initials: S
authors.lastname: Scalvini
authors.forename: Palmira
authors.initials: P
authors.lastname: Bernocchi
authors.forename: Gabriella
authors.initials: G
authors.lastname: Borghi
authors.forename: Caterina
authors.initials: C
authors.lastname: Tridico
authors.forename: Cristina
authors.initials: C
authors.lastname: Masella
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000523:psychology; D011787:Quality of Health Care; D019114:Remote Consultation / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000458:organization & administration / Q000592:standards*