Telemedicine Use in Primary Care for Children: 2019-2024

We lack national data on the maturing clinical use of telemedicine (TM) in children's primary care. This manuscript describes patterns of TM use for problem-based visits overall, across clinical domains, and associations of use with clinic visit volume.

We conducted a retrospective repeated cross-sectional analysis using electronic health records from 1088 pediatric and family medicine primary care practices nationwide, including children aged less than 18 years who received care between 2019 and 2024. We assessed monthly TM use by measuring problem-based visits per 1000 active primary care patients and the proportion conducted via TM, overall and within 6 distinct clinical domains. Regression modeling evaluated whether TM visit volume was associated with an increase, no change, or decrease in total visit volume.

The study included 19 633 472 problem-based visits (6% TM, 55% Medicaid, 14% Spanish language). TM represented less than 1% of visits in 2019, peaked at 55% in April 2020, and declined to 6% in 2024. In 2024, TM represented 20% of endocrinology (including obesity) visits and 15% of behavioral health visits compared to only 3% of respiratory visits. From 2019 to May 2023, each additional TM visit was associated with a non-significant net change in total visit volume (-0.1, 95% CI, -0.3-0.2). After May 2023, each additional TM visit was associated with an increase in total visit volume (2.02, 95% CI, 1.67-2.37).

Within primary care practices, TM use continues to meaningfully contribute to problem-based care delivery with variation across time and clinical domains.