Currently submitted to: Journal of Medical Internet Research
Date Submitted: Sep 11, 2026
Open Peer Review Period: Sep 12, 2026 - Nov 7, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Telehealth Preference and Health Care Utilization among Adult Telehealth Users with Chronic Conditions: Secondary Analysis of California Health Interview Survey Data
ABSTRACT
Background:
Telehealth is underutilized to access primary care by mid-life and older adults with chronic conditions. Emergency department over-utilization or delayed care may result from barriers to accessing primary care. We sought to address gaps in evidence around factors associated with telehealth preference over in-person care in adults with chronic conditions, and relationships between telehealth preference and delayed or forgone care or emergency department use.
Objective:
The primary goal of this study was to offer insights into potential disparities in telehealth preference in mid-life and older adults with chronic conditions and inform policy and clinical strategies to reduce delays in care and unnecessary emergency department utilization through telehealth expansion.
Methods:
We performed a secondary analysis of cross-sectional data from the 2023 California Health Interview Survey. Adult respondents with chronic health conditions who utilized telehealth in the past year were included. We used multivariable logistic regression to test associations between demographic and health characteristics, preference for telehealth, delayed or forgone care, and emergency department utilization.
Results:
In the sample of 5711 telehealth users, 58% preferred telehealth over in-person for future care. Those aged 60–69 years, females, and those with higher education and income had greater odds of preferring telehealth. Respondents who identified as Asian and those who were not exclusively English speakers had lower odds of preferring telehealth. Preference for telehealth was associated with lower odds of delayed or forgone care but had no significant associations with emergency department use.
Conclusions:
This study reveals disparities in telehealth preference among Californians with chronic conditions, shaped by sociodemographic and health-related factors. Future longitudinal studies are needed to confirm factors motivating telehealth preference, to develop telehealth programs tailored to the unique needs of aging individuals with chronic conditions and improve their timely utilization of quality health care services. Clinical Trial: Not applicable
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