Research In Practice Blog
Telemedicine Use in Primary Care for Children: 2019–2024
Video Abstract
Telemedicine involves real-time, two-way interactive communication between a patient and a clinician located remotely. For pediatric populations, it has the potential to bridge geographic barriers to care, improve access to primary and specialty care, enhance convenience and satisfaction for patients and families, and ultimately improve child health outcomes. However, there is limited evidence regarding how its usage has evolved across various conditions and clinical domains in recent years.
A new study published in Pediatrics by researchers from Children’s Hospital of Pittsburgh, the American Academy of Pediatrics Pediatric Research in Office Settings Network, OCHIN, and Children’s Hospital of Philadelphia (CHOP), including Clinical Futures experts Alexander Fiks, MD, MSCE, Janani Ramachandran, MS, MPH, Mary Kate Kelly, MPH, Julia Szymczak, PhD, and Robert Grundmeier, MD, explores the role of telemedicine in improving access to care.
The researchers examined national trends in problem-based telemedicine visits across six clinical domains from 2019 to 2024 and assessed whether the use of telemedicine was associated with changes in overall visit volumes.
How the Study Was Conducted:
Using electronic health records from 1,088 practices, including 966 community-based health centers, 76 regional health system practices and 46 AAP PROS network independent practices, the researchers conducted a retrospective, repeated cross-sectional analysis. The patient population was comprised of children under 18 years old receiving care at participating sites.
The researchers identified 6 clinical domains with the highest proportion of problem-based visits conducted via telemedicine throughout the study period. These included behavioral health (20%), endocrine (19%), dermatology (11%), infectious disease (11%), digestive health (10%), and respiratory health (9%). The study assessed monthly telemedicine use by measuring problem-based visits per 1,000 active primary care patients and the proportion of visits conducted via telemedicine, both overall and within the six distinct clinical domains. Regression modeling was then utilized to evaluate whether telemedicine visit volumes were associated with changes in total visit volumes.
Study Findings:
The study analyzed a total of 19,633,472 problem-based visits (6% telehealth, 55% Medicaid insured, 14% Spanish preferred language) over a six-year period.
In 2019, telemedicine accounted for less than 1% of problem-based visits. However, during the early months of the COVID-19 pandemic, its utilization surged to 55% of visits in April 2020, coinciding with an overall decline in visit numbers. By 2024, telemedicine made up 6% of problem-based visits, which is approximately 1 in 16 visits. In both 2020 and 2024, the same six clinical domains made up the majority of telemedicine visits, although the relative proportions of visits within each domain changed over time.
The study then examined the relationship between the monthly volume of telemedicine visits and the total monthly visit-volume to determine whether increased telemedicine usage led to an increase, decrease, or no change in problem-based visits at the practice level. In the peri-pandemic period, each additional telemedicine visit was associated with a non-significant net change in total visit volume (-0.1, 95% CI:-0.3 to 0.2). Post-pandemic, each additional telemedicine visit was associated with a net increase in total visit volume (2.02, 95% CI: 1.67 to 2.37).
What this research adds:
Throughout the study period, the same six clinical domains continued to dominate telemedicine-provided care. By the end of the study, telemedicine represented the largest share of problem-based visits in the endocrine (including obesity) and behavioral health domains. Researchers noted changes over time in the relationship between telemedicine use and the volume of problem-based visits. During the peri-pandemic period, telemedicine was linked to stable overall problem-based visit volumes but contributed to increased visit volumes in certain domains with increasingly common and clinically challenging conditions such as endocrine, behavioral health, and digestive health. In the subsequent post-pandemic period, a rise in telemedicine visits at the practice-month level correlated with higher problem-based visit volumes both overall and across the six clinical domains. This suggests that telemedicine has become a viable strategy to enhance the delivery of problem-based care in various clinical conditions.
The data revealed significant ongoing use of telemedicine for problem-based pediatric visits. Previous administrative data indicated that telemedicine usage peaked at 44% of such visits during the early 2020s but fell to 15% by the fall of 2020. In the current sample study, usage was higher in early 2020 (55%) and remained elevated in the fall of that year (28%). The EHR-based analysis extends through 2024, showing a continuing but gradually declining use of telemedicine (6% of all problem-based visits in 2024). This sustained usage implies that both clinical teams and families see ongoing value in this approach to care, highlighting the necessity for rigorous study designs to better understand their impact on access and quality, as well as to identify emerging best practices in innovative primary care settings.
The focus of telemedicine use within the study primarily addressed chronic conditions that increasingly affect families and require ongoing engagement for effective management. By the end of the study period in 2024, visits related to endocrinology, including dyslipidemias and obesity, emerged as one of the most common domains for telemedicine use. Following this, behavioral health—designated a national public health emergency in 2022 and where guidelines call for close follow-up—became the next most common area, particularly in the context of managing ADHD.
These findings align with those of a systematic review of telemedicine usage in children’s health, which noted that telemedicine was frequently used for obesity and mental health issues in the existing literature. For chronic conditions in these domains, enhancing access to ongoing care via telemedicine can supplement in-person care for situations that only periodically require a detailed physical examination, while also addressing family time constraints that often hinder access to care. Notably, results from the EHR data showing common telemedicine use by primary care clinicians for chronic conditions mirror those from a previous study based on parent surveys.
Despite evidence supporting the effectiveness of telemedicine, the proportion of dermatological complaints managed through this medium was lower in the study sample. This may reflect families’ preference for in-person care for dermatological issues or inconsistencies in the office systems for scheduling telemedicine visits for such problems. The findings suggest that there is a significant opportunity to increase the use of telemedicine in dermatological care within primary care settings.
Clinical Implications
In conclusion, telemedicine has become a common method for providing problem-based primary care to children overall and especially in areas such as endocrine and behavioral health where chronic needs are significant. Recently, telemedicine has also proven to be an important way to increase visit volume. These findings highlight the central role of telemedicine in primary care and emphasize the necessity for further exploration of its effects on health outcomes and accessibility. Learn more in this CHOP news release.
Additional information and research related to this topic:
- “Primary Care Telemedicine vs In-Person Antibiotic Prescribing for Pediatric Respiratory Tract Infections”- JAMA Network Open, published May 1, 2026
The study was supported by National Institutes of Health grant R01HD107153. Additional infrastructure funding was provided by the American Academy of Pediatrics and Health Resources and Services Administration of the US Department of Health and Human Services under grant U5DMC39344. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Clinical Futures Authors:
Alexander Fiks, MD, MSCE, Janani Ramachandran, MS, MPH, Mary Kate Kelly, MPH, Julia Szymczak, PhD, and Robert Grundmeier, MD