[Acceptance of telemedicine use among residents in rural and remote areas]

Objective　We broadly assessed how open residents in rural and remote areas are to using telemedicine, and whether an association exists between openness to telemedicine use and resident demographics including clinical visit status and advance care planning. Methods　A self-administered survey was disseminated via mail between October 2022 and January 2023. Participants included 3,767 residents of nine districts with remote and rural medical care services in Shunan City, Yamaguchi Prefecture aged ≥20 years. We selected participants using stratified random sampling by district, sex, and age. The survey comprised questions regarding willingness to use telemedicine services including online medical care and medication counseling, resident characteristics, clinical visit status, and willingness to accept long-term and terminal care. Multivariate logistic regression analysis was used to assess potential factors associated with willingness or unwillingness to use telemedicine. We also analyzed the specific reasons given in the responses of those who did not want to use telemedicine.Results　A total of 1,540 respondents were included in the final analyses (valid response rate: 40.9%). Regarding telemedicine use, 43.0% and 48.1% of respondents were willing to use online medical care in their family clinics and in their own houses, respectively. Additionally, 53.5% expressed a desire to use medication counseling clinics. Willingness to use telemedicine associated significantly with smartphone users and responders aged ≤50 years of age. Notably, hospital visitors and remote island residents were unwilling to use online medical care services. Time required to visit a hospital/clinic, residents living alone, and resident's desire to receive terminal care at home did not correlate significantly. The most common reasons given by those who did not want to use telemedicine were "easier to talk to someone in person (45.2-56.0%)," "never experienced it before (36.6-41.2%)," and "difficult to hear explanations (12.5-14.3%)." Other reasons (free responses) included "Don't know/don't need it (27.8-42.4%), "No problem with current hospital visit/pharmacy care (13.6-21.5%)," and "Concerns regarding equipment operation (10.4-18.2%).Conclusions　We identified factors associated with positive and negative attitudes toward telemedicine among residents of rural and remote areas. Our findings underscore the importance of promoting residents' understanding of the convenience and necessity of telemedicine by increasing their opportunities to experience it.