BACKGROUND: 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 from 2019 to 2024 and identify patient characteristics associated with telemedicine use. DESIGN 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 MEASURES: 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 encounterlevel characteristics, including demographics, insurance, patient portal use, income, clinical comorbidity, distance from care, provider specialty, encounter type, hospital index, and visit year. KEY RESULTS: 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. CONCLUSIONS: 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.
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