Telemedicine Use and Access to Care for New Patients at an Academic Cardiovascular Center: An Analysis of Geographic...

Telemedicine use has increased, but its impact on access to initial cardiac care remains understudied. We assessed the association of new patient visit modality with geographic reach and wait times at an academic cardiovascular center.

We extracted electronic health record data for NPVs from January 2017 to November 2023. We defined the center's traditional catchment area using the 80th percentile of patient-clinic distance for in-person NPVs before March 2020. For NPVs from July 2021 to November 2023 (study period), we used multivariable regression to assess the association of visit modality with the likelihood of living outside the catchment area and the time from scheduling to initial visit.

There were 16 407 NPVs (45.4% telemedicine). Average age was 58.6, with 50.4% women, 2.8% Black individuals, 12.7% Hispanic individuals, and 10.3% patients on Medicaid. Patients receiving telemedicine NPVs were more likely to live outside the catchment area (adjusted odds ratio, 1.83 [95% CI, 1.55-2.16]). Subgroup analyses revealed a larger effect for patients aged 65 to 79 years versus 45 to 64 years (adjusted odds ratio, 2.05 versus 1.53; P=0.03). Telemedicine NPVs had shorter times to visit than in-person NPVs (-8 days [95% CI, -3 to -13]). This effect was larger for patients on Medicaid versus private insurance (-13 versus -6 days; P=0.03).

New patients seen via telemedicine were more likely to reside outside the center's catchment area and had shorter wait times. Effects were more pronounced for older patients and those on Medicaid. Future studies should evaluate whether strategic implementation of telemedicine can broaden the geographic reach of cardiovascular centers and improve access for new patients.