Trajectories of In-Person and Remote Care Utilization: A Sequence Analysis of Primary Care Modalities Pre- and Post-COVID-19

The COVID-19 pandemic propelled the growth of virtual care, but few studies have examined how it reshaped care utilization patterns longitudinally across diverse populations. We used multichannel sequence analysis to classify 10,671 diabetic adults at two San Francisco health systems by utilization patterns from April 2019-March 2023. Patients who transitioned to digital care were Black or White, were Medicare beneficiaries, or had higher comorbidity burdens. Individuals who increased their combined in-person and virtual healthcare utilization were Hispanic with Spanish language preference and had greater disease burden. Those who decreased care utilization overall were Asian with Chinese language preference and had low patient portal engagement. While technology-enabled care models have the potential to enhance access, certain populations may be at risk of reduced access to care. Health systems should consider targeted interventions to ensure equitable access to telehealth for populations at risk of digital exclusion with the growth of remote care.