| Sumario: | Background: The coronavirus disease pandemic spurred a rapid global expansion of telemedicine facilitated by relaxed regulations. While telemedicine can improve access to underserved populations, disparities persist due to demographic, socioeconomic, and geographic factors. In Japan, telemedicine use expanded during the pandemic; however, evidence on post-pandemic utilization remains limited. Objective: To examine telemedicine use during the late- and post-pandemic periods from 2022 to 2024 and identify individual- and municipal-level factors associated with use. Methods: A quantitative retrospective cohort study was conducted in Hokkaido, Japan using administrative claims data. Participants were eligible with at least two outpatient visits between October 2021 and March 2022. These individuals were followed from April 2022 to December 2024 to collect data on the primary outcome: outpatient visit involving telemedicine. Data analysis evaluated associations between the outcome and 34 variables (six individual-level and 28 municipal-level) conceptualized according to Andersen's behavioral model of health service use. Results: Of the 1,482,239 eligible individuals, 0.4% (n=5,965) used telemedicine. The intraclass correlation coefficient indicated that 39% of the variance was attributable to municipal-level factors, rising to 54% among those aged ≥75. Models including population health needs explained most variance (proportional change in variance, 18.5%). Higher telemedicine use was associated with female gender, higher Elixhauser Comorbidity Index, prior opioids or psycholeptic prescriptions, prior telemedicine use, higher proportion of population aged ≥65, financial power index, and more single-parent households. Lower telemedicine use was linked to older age, higher proportion of women aged ≥65, higher proportion engaged in secondary industry, and higher proportion of elderly-only couple households. Conclusion: Telemedicine use in late- and post-pandemic Japan remains low, with marked regional disparities. Population health needs are key determinants, and municipal-level influences are stronger among older adults. Increasing uptake requires infrastructure and policies supporting caregiver involvement and reducing barriers for older and digitally disadvantaged populations.
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