Associations between Patient- and Provider Level Factors, and Telemedicine Use in Family Medicine Clinics

Abstract

Introduction: Increased telemedicine implementation may promote primary care access. However, gaps in telemedicine uptake may perpetuate existing disparities in primary care access. This study assessed provider- and patient-level factors associated with telemedicine use in community-based family practice clinics.

Methods: This retrospective study used electronic medical records data from a large Federally Qualified Health Center. A 3-level mixed-effects logistic regression model explored predictors of telemedicine use, with provider and patient as random effects.

Results: The analytic sample included 37,428 unique patients with 106,567 primary care encounters with 42 family medicine providers. Fifty-seven percent of the sample identified as Hispanic, 28% non-Hispanic White, and 11% non-Hispanic Black. Compared to Hispanics, non-Hispanic White patients had 61% higher odds of a telemedicine visit, and non-Hispanic Black patients had 32% higher odds of a telemedicine visit. The odds of telemedicine use were lower for those who were uninsured. Those residing in metropolitan areas or medically underserved areas had greater odds of a telemedicine appointment. Commute time exhibited a dose-response relationship with telemedicine use. Provider characteristics were not significantly associated with telemedicine use.

Discussion: While provider characteristics were not associated with telemedicine use, greater focus on patient characteristics specific to the population served is necessary.

Keywords: Electronic Health Records; Family Medicine; Health Services Accessibility; Logistic Models; Medically Underserved Area; Medically Uninsured; Primary Health Care; Retrospective Studies; Telemedicine.