title: Integrating telemedicine in urban pediatric primary care: provider perspectives and performance.
abstract: BACKGROUND
  Health-e-Access, an urban telemedicine service, enabled 6,511 acute-illness telemedicine visits over a 7-year period for children at 22 childcare and school sites in Rochester, NY.
  
  
  OBJECTIVE
  The aims of this article were to (1) describe provider attitudes and perceptions about efficiency and effectiveness of Health-e-Access and (2) assess hypotheses that (a) providers will complete a large proportion of the telemedicine visits attempted and (b) high levels of continuity with the primary care practice will be achieved.
  
  
  METHODS
  This descriptive study focused on the 24-month Primary Care Phase in the development of Health-e-Access, initiated by the participation of 10 primary care practices. Provider surveys addressed efficiency, effectiveness, and overall acceptability. Performance measures included completion of telemedicine visits and continuity of care with the medical home.
  
  
  RESULTS
  Among survey respondents, the 30 providers who had completed telemedicine visits perceived that decision-making required slightly less time and total time required was slightly greater than for in-person visits. Confidence in diagnosis was somewhat less for telemedicine visits. Providers were comfortable collaborating with telemedicine assistants and confident that communications met parent needs. Among the 2,554 consecutive telemedicine visits attempted during the Primary Care Phase, 2,475 (96.9%) were completed by 47 providers. For visits by children with a participating primary care practice, continuity averaged 83.2% among practices (range, 28.1-92.9%).
  
  
  CONCLUSIONS
  Providers perceived little or no advantage in efficiency or effectiveness to their practice in using telemedicine to deliver care; yet they used it effectively in serving families, completing almost all telemedicine visits requested, providing high levels of continuity with the medical home, and believing they communicated adequately with parents.
authors.affiliation: Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, USA. ken_mcconnochie@urmc.rochester.edu
authors.forename: Kenneth
authors.initials: K
authors.lastname: McConnochie
authors.forename: Nancy
authors.initials: N
authors.lastname: Wood
authors.forename: Neil
authors.initials: N
authors.lastname: Herendeen
authors.forename: Cynthia
authors.initials: C
authors.lastname: ten Hoopen
authors.forename: Larry
authors.initials: L
authors.lastname: Denk
authors.forename: Judith
authors.initials: J
authors.lastname: Neuderfer
mesh_terms: D003266:Continuity of Patient Care; D019538:Health Care Surveys; D006801:Humans; D009518:New York; D010372:Pediatrics; D011203:Poverty; D011320:Primary Health Care; D017216:Telemedicine / Q000458:organization & administration*; D019037:Urban Health Services
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