**1. Introduction**

Aside from emerging evidence on the clinical impact of telemedicine, which has shown that it can provide e ffective health services at a lower cost [1–3], telemedicine services enjoy a high degree of acceptance among the public, as studies show that it saves them significant time [4–7]. In addition, it has been shown that avoiding travel to health centers can reduce air pollution in the context of the current climate crisis [8,9]. While clinician acceptance is a key factor for sustainable telemedicine services [10–12], evidence is mixed. A comprehensive systematic review reported that clinicians were highly satisfied with both store-and-forward and real time telemedicine [13]. However, other evidence suggested a subtle/nuanced e ffect: although services are generally well accepted by professionals, they express concerns regarding the increased workload that this might entail [14,15]. Such concerns appear to be more prevalent among primary care physicians than among nursing sta ff, who also express a fear that telemedicine could potentially undermine their professional autonomy [16]. While some studies sugges<sup>t</sup> that telemedicine is better accepted by patients who live in rural areas [17], professionals in these fields are also more satisfied with the service as it facilitates contact with hospital specialists, improving their professional development [18,19]. Other studies also show the benefits of telemedicine for professionals in terms of professional development [20,21], as well as suggesting that it enabled them to approach their patients with greater knowledge [22].

The Catalan Health Care System dispenses services for 7.6 inhabitants, providing universal coverage through a tax-based system. Administratively, it is composed by a single public payer and multiple service providers publicly or privately owned, with an integrated system. Some of its peculiarities are the role of community and primary health care and the increasing use of information technologies and digital health [23]. In Catalonia, telemedicine is used in numerous areas, such as screening, diagnosis and the treatment of disease, asynchronously in particular. The most widely used are interconsultations between primary and hospital care professionals and teleconsultations between primary care professionals and patients [24]. With regard to the former, evidence suggests that they are cost-e ffective, serve to reduce face-to-face visits and that the economic benefit is mainly enjoyed by the patient [2]. Regarding the latter, recent studies show that they can also be useful in reducing face-to-face visits mainly for administrative reasons [25,26]. If, as these experiences suggest, telemedicine is shown to be socially desirable, it is important that healthcare professionals (who are the ones who make the decision to use it) are satisfied with it, even though it may not be of any particular benefit to them, meaning that they are active promoters of such services.

Numerous questionnaires attempt to study the acceptance of healthcare professionals regarding telemedicine [27–29]. Among them is the validated Catalan version of the "Health Optimum Questionnaire" [30], inspired by the areas and simplicity of the technology acceptance model [31]. In this context, the objective of this study was to assess the acceptance of telemedicine services among primary care professionals in the Catalan central region using the aforementioned questionnaire, and to describe the factors which may determine the use of telemedicine services in the future.
