Patterns of Telemedicine Use and the Digital Divide Among Adults in Poland's Postpandemic Era: Nationwide Cross-Sectional Survey.

چکیده اصلی

BACKGROUND: The COVID-19 pandemic transformed telemedicine in Poland from a niche service into a core mode of health care delivery, supported by nationwide eHealth infrastructure such as obligatory e-prescriptions and the central P1 platform. Despite this rapid expansion, concerns persist that the benefits of digital health are not shared equally, and that a digital divide limits equitable access to telemedicine services across sociodemographic and geographic groups. OBJECTIVE: This study aimed to describe the patterns of telemedicine and eHealth tool use among Polish adults in the postpandemic era, to identify key sociodemographic, economic, and health-related predictors of their adoption, and to map digital inequalities in access to health care services. METHODS: This cross-sectional study used data from the "National Test for Poles' Health" (Narodowy Test Zdrowia Polaków), a nationwide online survey conducted annually in Poland between 2020 and 2024. The full surveyed sample comprised 1,196,102 adults, of whom 820,000 completed the telemedicine-use module and formed the analytic sample; detailed questions on 12 specific eHealth services were administered to a randomly assigned subsample of 120,000 respondents under a split-questionnaire design. Sociodemographic factors (age, gender, education level, and place of residence), health status, and barriers to accessing care were analyzed as predictors using ordered and binary logistic regression models, with results expressed as odds ratios (ORs) with 95% CIs, and statistical significance set at P≤.05. RESULTS: Overall, 49.7% (407,502/820,000) of respondents reported using a telemedicine visit at least once in the preceding 12 months. Telephone consultations were the most common form of remote visit (43,598/120,000, 36.3%), whereas video consultations were rare (8736/120,000, 7.3%). System-driven tools showed high adoption (e-prescriptions: 87,121/120,000, 72.6%; e-referrals: 64,083/120,000, 53.4%), while patient-driven tools, such as mobile health apps (24,341/120,000, 20.3%), were used less frequently. Education and place of residence were the strongest sociodemographic predictors: participants with a master's degree were 2.2 times more likely than those with secondary education to use the Internet Patient Account (OR 2.2, 95% CI 2.1-2.2), and residents of cities with over 500,000 inhabitants had higher odds of telemedicine use (OR 1.5, 95% CI 1.5-1.6). Chronic disease was a strong health-related predictor (OR 1.8, 95% CI 1.7-1.9). Gender differences were also observed: women used telephone consultations more often, whereas men more frequently used the Internet Patient Account. CONCLUSIONS: Telemedicine adoption in postpandemic Poland is driven more by pre-existing socioeconomic advantage, particularly higher education and urban residence, than by clinical need alone, indicating a persistent digital divide. Telemedicine functions largely as a tool of convenience for the already connected rather than a tool of necessity for underserved groups. Targeted interventions, including community-based digital literacy programs, investment in rural broadband infrastructure, and guaranteed hybrid in-person alternatives, are needed to ensure that Poland's eHealth transformation promotes inclusion rather than exacerbating health inequalities.

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