Temporal Trends and Sociodemographic Differences in Telemedicine Utilization, 2019-2024.

Abstract

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. To characterize telemedicine utilization from 2019 to 2024 and identify patient characteristics associated with telemedicine use. 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. The primary outcome was whether each outpatient encounter was conducted via telemedicine (vs in-person). We used multivariable logistic regression clustering on patients to assess associations between telemedicine use and patient- and encounter-level characteristics, including demographics, insurance, patient portal use, income, clinical comorbidity, distance from care, provider specialty, encounter type, hospital index, and visit year. The study included 46,149,734 visits among 2,248,341 patients. Telemedicine surged from 1% of visits pre-pandemic to 17% in April 2020, stabilized at 8-13% through late 2020, and remained 4-6% from 2022 to 2024. Telemedicine use was lower among older adults (aOR 0.67 for ages 40-64; 0.47 for ≥ 65 vs. < 40 years), males (aOR 0.90), and new visits (aOR 0.46). Higher use was observed among unmarried (aOR 1.10), patient portal users (aOR 1.44), patients with fewer comorbidities, those living ≥ 15 miles from care (aOR 1.42 vs. < 5 miles), lower-income (< $50,000 aOR 1.06 vs. $50,000-$100,000), and primary care (aOR 1.23 vs. specialty care). Telemedicine use was lower among Non-Hispanic Black (aOR 0.88), Hispanic (aOR 0.94), and Asian (aOR 0.82) patients compared to Non-Hispanic White patients. Patterns differed by clinical condition, with disproportionately higher use among White patients with mental health disorders. Telemedicine use persists post-pandemic but reflects differences in access by age, race/ethnicity, socioeconomic status, and prior engagement with the patient portal. Targeted policies are needed to ensure equitable telemedicine adoption and accessibility for all patients.