Service to Improve Healthcare in Rural Areas

Topics: Health care, Health economics, Medicine Pages: 15 (5851 words) Published: August 24, 2013
Teleconsultation service to improve healthcare in rural areas: acceptance, organizational impact and appropriateness -------------------------------------------------


Nowadays, new organisational strategies should be indentified 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. -------------------------------------------------

National Health Systems (NHSs) are currently facing the challenge of providing better quality health care (HC) and, at the same time, containing costs. Primary care has a relevant role in the current health services scenario. General Practitioners (GPs) - more commonly referred to as Family Medicine in the US, Canada and some European countries [1] - are responsible for the primary evaluation of patients' health status, in particular for the initial steps needed to provide care for any health problem [2] and to supply access to preventive tests and secondary care [3]. The importance of primary care is mainly due to three reasons: 1. GPs contribute to the appropriateness of care, defined as the outcome of a decision-making process that should maximise individual health benefits in view of the available resources [4], with special reference to the growing burden of the elderly and chronically-ill patients [5]. 2. Primary care is crucial in the frame of containing costs [6], providing more efficacious actions thus preventing unnecessary hospital accesses, improving timeliness of care and reducing waiting lists [7]. 3. GPs have to ensure the best possible access for those patients needing care [2] also providing appropriate care for those who live in remote rural areas and who might have logistic barriers to access secondary care [8], such as distances, transportation costs and a consequent lack of timeliness of care [9]. In fact, accessibility to health care systems (HCS) is a major problem in rural areas [10], with consequent higher disease and mortality rate [11], which, in turn, can also cause rural to urban migration [12]. Nowadays, new organisational strategies should be indentified to improve primary care and its link with secondary care in terms of efficacy and timeliness of interventions [13]. Telemedicine (TM), defined as the use of electronic...

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