title: Factors associated with the use of a teleconsultation system in Brazilian primary care.
abstract: BACKGROUND
  The Telehealth Network of Minas Gerais (TNMG) is a public telehealth service that provides support to primary healthcare in Minas Gerais, Brazil, performing teleconsultation and tele-electrocardiography. The aim of this study was to assess teleconsultation requests received by the TNMG and to investigate the factors associated with low teleconsultation utilization in most municipalities.
  
  
  METHODS
  A cross-sectional study was carried out including 214 municipalities. Indicators were defined to analyze teleconsultation requests. A structured questionnaire was used to investigate factors associated with teleconsultation utilization, which were analyzed by multivariate analysis through a decision tree algorithm (chi-squared automatic interaction detector) to the entire population of the study and logistic regression for municipalities that had used the system during the analyzed period.
  
  
  RESULTS
  From May to September 2009, 1,954 teleconsultations were performed. The average number (±standard deviation) of teleconsultations per municipality was 1.71 (±1.50) per month. The majority of the users were located in remote regions with a low Human Development Index. The decision tree showed "conduction of sufficient training" (p=0.0015) as the factor with the greatest positive impact on teleconsultation utilization, followed by "ability to discuss clinical cases outside the teleconsultation system" (p=0.0192). Logistic regression analysis revealed two factors associated with increased use of the system: "complexity of the system" (odds ratio=3.35; 95% confidence interval [CI], 1.58-7.09) and whether they considered that the "service helps to solve everyday problems" (odds ratio=4.37; 95% CI, 1.14-16.69).
  
  
  CONCLUSIONS
  The study of factors associated with the low use of the teleconsultation system of the TNMG may help policy makers define strategies to improve the use of teleconsultation services.
authors.affiliation: 1University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Maria B M
authors.initials: MB
authors.lastname: Alkmim
authors.affiliation: 1University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.|2Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Milena S
authors.initials: MS
authors.lastname: Marcolino
authors.affiliation: 3School of Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Renato M
authors.initials: RM
authors.lastname: Figueira
authors.affiliation: 1University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Lidiane
authors.initials: L
authors.lastname: Sousa
authors.affiliation: 1University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Mariana S
authors.initials: MS
authors.lastname: Nunes
authors.affiliation: 4Medical School, Universidade Federal de São João del Rei, Divinópolis, Brazil.
authors.forename: Clareci S
authors.initials: CS
authors.lastname: Cardoso
authors.affiliation: 1University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.|2Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Ribeiro
mesh_terms: D000328:Adult; D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care; D019114:Remote Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: primary healthcare; teleconsultation; telehealth; telemedicine