**4. Discussion**

In a public health system such as the one found in Catalonia, in which health professionals can choose between telemedicine and usual care (you cannot force them to use telemedicine), understanding the "drivers" of acceptance is essential, so that its use is widespread. The short questionnaire used in this study has allowed an easy, massive and real-time measurement of professional acceptance. If telemedicine is shown to be socially desirable, it is important that health professionals (who are the ones who make the decision to use it) are satisfied, although it may not be of particular benefit to them, so that they become active promoters. This study shows that, in general, the professionals in central Catalonia who responded to the survey are pleased with the telemedicine services available to them and that they will continue to use them as they are currently designed. They state that these services have an overall perceived quality similar to usual care; they do not show any anxiety when using them and believe that they can improve the health of their patients.

However, the Catalan public health system needs to improve in terms of the technical and organizational di fficulties which the professionals claim to have su ffered while using the services; key elements for their acceptance: since those who had di fficulties would be more reluctant to use the services in the future. It is worth noting that none of the healthcare professionals received any training prior to the utilization of the telemedicine services, and nor did new health professionals who joined the primary care teams. If the healthcare professionals had received some form of training, they would probably have had fewer of the di fficulties which negatively a ffect the use of the services. Furthermore, the results show that we can expect a high degree of acceptance by nurses in managing a systemic change towards models with more telemedicine services, unlike that which was shown in other studies [16].

Respondents who used the telemedicine services more often rated the quality of care of these services significantly lower than respondents who use them less often and reported having experienced more technical di fficulties and more organizational and other di fficulties, compared with respondents who used telemedicine less often. The fact that those who use the tools more are more critical is a wake-up call to technical managers of telemedicine services, suggesting that their experiences should be incorporated into the development of the technology.
