title: Rational development of telehealth to support primary care  respiratory medicine: patient distribution and  organisational factors.
abstract: OBJECTIVE
  Telehealth may offer opportunities to support primary and secondary care of patients with respiratory disease. This study examined  the potential for applying telehealth in a region of the UK by exploring the distribution of patients and examining attitudes to  implementation of telehealth.
  
  
  METHODS
  The distribution of patients with asthma, COPD, lung cancer and obstructive sleep apnoea (OSAS) in the NHS Highland Region  (309,900 residents, 12,507 square miles) was determined from Quality and Outcomes Framework data and disease registers. Qualitative  interviews with health professionals (n=20) focussing on the potential for telehealth in respiratory medicine were analysed using the  Normalisation Process Model.
  
  
  RESULTS
  The most remote general practices accounted for 40% of patients with asthma (7198/17822), 45% of those with COPD  (2145/4721), 33% of lung cancer (199/605) and 35% of OSAS (169/489) patients. Urban figures were 28% of asthma patients, 26% of  COPD patients, 25% of lung cancer and 31% of OSAS patients. Interviewees identified a range of telehealth applications they considered  potentially beneficial including management, information and communication systems. However, they also identified challenges - mainly  related to training, costs and infrastructure.
  
  
  CONCLUSIONS
  Tailoring telehealth to support management of respiratory diseases in primary care requires knowledge of patient  distribution, which will impact on the nature and feasibility of services. Individual and organisational capacities and attitudes are also likely  to influence successful implementation.
authors.affiliation: Centre for Rural Health, University of Aberdeen, Inverness, UK.
authors.forename: David John
authors.initials: DJ
authors.lastname: Godden
authors.forename: Gerry
authors.initials: G
authors.lastname: King
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008173:Lung Diseases, Obstructive / Q000453:epidemiology; D008175:Lung Neoplasms / Q000453:epidemiology; D011320:Primary Health Care; D015272:Pulmonary Medicine / Q000379:methods*; D012042:Registries; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012606:Scotland; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology; D017216:Telemedicine; D019037:Urban Health Services / Q000706:statistics & numerical data*