Structural Determinants of Telehealth Use Among Patients Presenting to an Urban Safety-Net Emergency Department

Telehealth expanded rapidly during and after the COVID-19 era. However, adoption remains uneven in safety-net populations, where structural barriers may limit use and worsen disparities.

To identify structural and healthcare access factors associated with telehealth use among adults presenting to an urban safety-net emergency department (ED) and evaluate whether telehealth use was associated with ED utilization.

We conducted a cross-sectional survey of adults presenting to an urban safety-net ED in the Bronx, New York, between July and November 2025. The survey assessed prior telehealth use, primary care provider (PCP) status, home internet access, technology comfort, and ED visit frequency. Multivariable logistic regression identified factors associated with telehealth use. Adjusted Poisson regression assessed associations with ED visit frequency.

Of 326 patients screened, 301 completed the survey (92% response rate). The median age was 45.5 years (IQR 34-61), 52.8% were female, and 42.9% reported prior telehealth use. In adjusted analyses, no primary care provider (aOR 0.32, 95% CI 0.18-0.58), no home internet access (aOR 0.33, 95% CI 0.12-0.88), and male sex (aOR 0.42, 95% CI 0.25-0.70) were independently associated with lower telehealth use. Age, race/ethnicity, Medicaid insurance, and technology comfort were not associated with telehealth use. Prior telehealth use was not associated with ED visit frequency (aIRR 1.05, 95% CI 0.92-1.20).

Telehealth use in this safety-net ED population was driven by primary care linkage and internet access. Efforts to promote equitable telehealth adoption should prioritize improvements in primary care access and digital connectivity.