{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T08:02:50Z","timestamp":1785225770433,"version":"3.55.0"},"reference-count":27,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Cross-ministerial Strategic Innovation Promotion Program (SIP) on \u201cIntegrated Health Care System\u201d","award":["JPJ012425"],"award-info":[{"award-number":["JPJ012425"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health&amp;#65533;Serv&amp;#65533;Insights"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2019s behavioral model of health service use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 \u226575. 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 \u226565, financial power index, and more single-parent households. Lower telemedicine use was linked to older age, higher proportion of women aged \u226565, higher proportion engaged in secondary industry, and higher proportion of elderly-only couple households.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11786329261473469","type":"journal-article","created":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T09:01:46Z","timestamp":1785056506000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Regional Differences in Telemedicine Utilization by Patient in Late and Post-COVID-19 Pandemic Japan"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3779-3628","authenticated-orcid":false,"given":"Kazuki","family":"Ohashi","sequence":"first","affiliation":[{"name":"Hokkaido University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Abe","sequence":"additional","affiliation":[{"name":"Hokkaido University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0150-0133","authenticated-orcid":false,"given":"Yoko","family":"Shizawa","sequence":"additional","affiliation":[{"name":"Hokkaido University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao","family":"Jieyu","sequence":"additional","affiliation":[{"name":"Hokkaido University"},{"name":"Hokkaido University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Machiko","family":"Ukai","sequence":"additional","affiliation":[{"name":"Hokkaido University"},{"name":"Teine Keijinkai Hospital"},{"name":"Sapporo, Hokkaido"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigekazu","family":"Komoto","sequence":"additional","affiliation":[{"name":"Hokkaido University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuhiko","family":"Ogasawara","sequence":"additional","affiliation":[{"name":"Hokkaido University"},{"name":"Sapporo, Hokkaido"},{"name":"Muroran Institute of Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","unstructured":"OECD. The COVID-19 Pandemic and the Future of Telemedicine. OECD Health Policy Studies. OECD Publishing. 10.1787\/ac8b0a27-en.","DOI":"10.1787\/ac8b0a27-en"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pdig.000427"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.2196\/39181"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.202553150"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","unstructured":"Oliveira HT. Bringing health care to the patient: An overview of the use of telemedicine in OECD countries OECD Health Working Papers 116. OECD Publishing; 2020. 10.1787\/8e56ede7-en.","DOI":"10.1787\/8e56ede7-en"},{"key":"e_1_3_6_7_2","unstructured":"Ministry of Health Labour and Welfare. Guidelines for the appropriate implementation of online medical care. 2023. https:\/\/www.mhlw.go.jp\/stf\/index_0024_00004.html. Accessed April 22 2026."},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.2196\/27982"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/OI9.0000000000000155"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.2196\/50938"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1089\/tmr.2023.0054"},{"key":"e_1_3_6_12_2","unstructured":"Ministry of Health Labour and Welfare. Agenda for the 4th Subcommittee on Research and Evaluation of Inpatient and Outpatient Medical Care in FY2025. 2025. https:\/\/www.mhlw.go.jp\/stf\/shingi2\/0000212500_00273.html. Accessed April 22 2026."},{"key":"e_1_3_6_13_2","unstructured":"Ministry of Internal Affairs and Communications. Population Census. 2020. https:\/\/www.e-stat.go.jp\/en. Accessed April 22 2026."},{"key":"e_1_3_6_14_2","unstructured":"Ministry of Health Labour and Welfare. Survey on the insured of the medical-care system for the latter-stage elderly. 2022. https:\/\/www.e-stat.go.jp\/en. Accessed April 22 2026."},{"key":"e_1_3_6_15_2","unstructured":"Ministry of Health Labour and Welfare. Survey on National Health Insurance. 2022. https:\/\/www.e-stat.go.jp\/en. Accessed April 22 2026."},{"key":"e_1_3_6_16_2","volume-title":"Changing the US health care system: key issues in health services policy and management","author":"Kominski GF","year":"2013","unstructured":"Kominski GF. Changing the US health care system: key issues in health services policy and management. John Wiley & Sons; 2013."},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-025-01599-x"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pop.2022.04.002"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.2196\/51279"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.20853"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.1620\/tjem.2022.J107"},{"key":"e_1_3_6_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.3354"},{"key":"e_1_3_6_24_2","volume-title":"Revision of medical fees for FY2024","author":"Ministry of Health Labour and Welfare","year":"2025","unstructured":"Ministry of Health Labour and Welfare. Revision of medical fees for FY2024; 2025. https:\/\/www.mhlw.go.jp\/stf\/seisakunitsuite\/bunya\/0000188411_00045.html. Accessed April 22, 2026."},{"key":"e_1_3_6_25_2","doi-asserted-by":"publisher","DOI":"10.2196\/23539"},{"key":"e_1_3_6_26_2","doi-asserted-by":"publisher","DOI":"10.2196\/52124"},{"key":"e_1_3_6_27_2","doi-asserted-by":"publisher","DOI":"10.2196\/43604"},{"key":"e_1_3_6_28_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.8954"}],"container-title":["Health Services Insights"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11786329261473469","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11786329261473469","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11786329261473469","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T07:47:14Z","timestamp":1785224834000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11786329261473469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":27,"alternative-id":["10.1177\/11786329261473469"],"URL":"https:\/\/doi.org\/10.1177\/11786329261473469","relation":{},"ISSN":["1178-6329","1178-6329"],"issn-type":[{"value":"1178-6329","type":"print"},{"value":"1178-6329","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"article-number":"11786329261473469"}}