The Determinants of Telemedicine Utilization; A Systematic Review

Abstract

Telemedicine utilization expanded dramatically during the COVID-19 pandemic, transforming healthcare delivery across diverse clinical settings. Although numerous studies have examined predictors of telemedicine use, determinants remain conceptually fragmented across patient, provider, and policy domains. This systematic review synthesizes empirical evidence on the determinants of telemedicine utilization using an expanded multilevel framework grounded in the Andersen Behavioral Model. Following PRISMA guidelines, electronic databases (PubMed, Scopus, and Web of Science) were searched for peer-reviewed studies examining predictors, barriers, or facilitators of telemedicine use. Eligible designs included observational studies, surveys, cohort studies, systematic reviews, qualitative investigations, and policy analyses. Determinants were coded across individual, provider/organizational, and policy levels, and findings were synthesized narratively due to methodological heterogeneity. Forty-six studies met inclusion criteria. Individual-level determinants particularly age, race and ethnicity, socioeconomic status, digital literacy, and clinical need were the most frequently examined predictors. However, utilization patterns were consistently shaped by enabling resources such as broadband access, insurance coverage, and digital infrastructure. Provider and organizational factors, including workflow integration, technological readiness, and specialty-specific adaptability, further influenced adoption. At the policy level, reimbursement parity and regulatory flexibility emerged as critical structural drivers of telemedicine expansion. Despite rapid growth during the pandemic, persistent sociodemographic disparities suggest that policy reform alone is insufficient to ensure equitable access. Telemedicine utilization reflects a multilevel system of interacting structural, organizational, and individual determinants, underscoring the need for coordinated policy alignment, institutional readiness, and equity-focused digital inclusion strategies to support sustainable integration.