Telemedicine Utilization Trajectories and Sociodemographic Differences, 2019-2024
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IMPORTANCE
Telemedicine usage surged during the COVID-19 pandemic, shaping how patients access healthcare services. Its sustained role in post-pandemic healthcare may uncover long-term trends and variations in utilization.
OBJECTIVE
To characterize telemedicine utilization patterns from 2019 to 2024 and identify patient characteristics associated with telemedicine use.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study analyzed outpatient visits across five hospitals within the University of Pennsylvania Health System (Penn Medicine) from January 1, 2019, to September 30, 2024.
MAIN OUTCOMES AND MEASURES
The primary outcome was the proportion of visits conducted through telemedicine. Multivariable logistic regression models were employed to assess association between telemedicine use and patient characteristics including demographics, insurance type, patient portal use, and socioeconomic status.
RESULTS
The study included 46,149,734 visits among 2,248,341 patients. Following the declaration of the COVID-19 pandemic in March 2020, telemedicine surged from 1% to 17% of outpatient encounters by April 2020, stabilizing at 8-13% for the rest of the year. Usage declined in 2021 but remained at 4-6% from 2022 to 2024. In multivariable models, older adults were less likely to use telemedicine compared to those under 40 years (40-64 years: aOR, 0.67 [95% CI, 0.67-0.67]; ≥65 years: aOR, 0.46 [95% CI, 0.46-0.46]). Higher telemedicine use was observed among women (male: aOR, 0.91 [95% CI, 0.91-0.92]), unmarried individuals (aOR, 1.10, 95% CI, 1.10-1.11), patient portal users (aOR, 1.44 [95% CI, 1.43-1.45]), patients with fewer comorbidities (Charlson Comorbidity Index scores ≥3: aOR, 0.87 [95% CI, 0.87-0.88]), those living farther from the place of service (5-15 miles: aOR, 1.04 [95% CI, 1.04-1.04]; ≥15 miles: aOR, 1.44 [95% CI, 1.43-1.44]; reference: <5 miles), lower-income individuals (<$50,000: aOR, 1.06 [95% CI, 1.06-1.07]; ≥$100,000: aOR, 0.91 [95% CI, 0.91-0.92]; reference: $50,000-$100,000), and primary care compared to specialty care (aOR, 1.19 [95% CI, 1.18-1.20]). Return patients used telemedicine more than new patients (new: aOR, 0.47 [95% CI, 0.47-0.47]). Telemdicine use varied by race/ethnicity, with lower use among Non-Hispanic Black (aOR, 0.89 [95% CI, 0.88-0.89]), Hispanic (aOR, 0.95 [95% CI, 0.95-0.96]), and Asian (aOR, 0.83 [95% CI, 0.82-0.83]) patients compared to Non-Hispanic White patients. Patterns varied across visit types (e.g., diabetes, mental disorders, sleep disorders, heart failure, COPD, CAD, and GI disorders), though younger, female, and geographically distant patients consistently used telemedicine more. Non-Hispanic White patients with mental disorders exhibited disproportionately higher telemedicine use, underscoring racial/ethnic differences that persisted during and after the pandemic, likely influenced by differences in access and coverage.
CONCLUSIONS AND RELEVANCE
Telemedicine use is higher among tech-friendly populations, including, younger individuals, female, return patients, and those living farther from healthcare facilities. However, difference by age, socioeconomic status, and race/ethnicity persist, suggesting barriers in access, digital literacy, and coverage. Targeted policies are needed to ensure equitable telemedicine adoption and accessibility for all patients.
Key Points
Question
What has been the trajectory of telemedicine usage since the COVID-19 pandemic, and which sociodemographic factors are associated with its persistent use?
Findings
Telemedicine visits to the University of Pennsylvania Health System (Penn Medicine) surged with the onset of the COVID-19 pandemic in 2020. While telemedicine has since remained a significant component of outpatient care, its use has been uneven. Younger adults, women, patient portal users, unmarried individuals, return patients, and those with lower Charlson Comorbidity Index scores, were more likely to use telemedicine services. Moreover, racial and ethnic minorities, as well as socioeconomically disadvantaged populations, displayed varying patterns of telemedicine access, highlighting differences in utilization.
Meaning
Persistent differences in telemedicine use across primary care and specialty services highlight factors influencing its adoption, suggesting opportunities for targeted strategies to improve equity in digital healthcare access.
