Telemedicine and primary care: reach and limitations post-pandemic

INTRODUCTION

Telemedicine has established itself as an innovative tool that transforms the delivery of health care. This model relies on information technologies to facilitate remote consultations, diagnoses, and medical follow-up, overcoming geographical barriers and optimizing resources【1】. Various studies have shown that its implementation improves access to health services, especially in rural areas or those with a shortage of professionals, and helps streamline care processes in high-demand urban areas【2】. The COVID-19 pandemic significantly accelerated its adoption, making it a key strategy for ensuring the continuity of patient care during a global health emergency【3】.

Despite these advances, questions remain that need to be addressed. While its potential to democratize access to healthcare is recognized, limitations remain related to technological infrastructure, the population’s digital literacy, and cultural resistance from certain sectors of the healthcare system【4】. The lack of sufficient local evidence regarding its effectiveness and sustainability in the post-pandemic period underscores the need to assess its true impact on the quality of care and on the relationship between patients and healthcare professionals【5】.

In this regard, the present study aims to delve deeper into the scope and limitations of telemedicine in primary care following the pandemic, evaluating its benefits, challenges, and opportunities for improvement. The central hypothesis posits that this modality has facilitated access to consultations and disease prevention in underserved areas. However, structural and social barriers persist that hinder its full integration into the healthcare system【6】.

MATERIALS AND METHODS

This study was conducted as an integrative narrative review, involving a thematic analysis of scientific and regulatory literature, prioritizing high-quality primary studies and systematic reviews published between 2019 and 2025. Its focus is on analyzing the implementation, scope, and limitations of telemedicine in primary health care, with special emphasis on the period following the COVID-19 pandemic.

1. Design

A descriptive review design was chosen because the objective was to gather, organize, and analyze information from scientific and regulatory sources on telemedicine. This type of study allows for the identification of advances, benefits, barriers, and prospects without directly intervening in a specific population【1】.

2. Search Strategy and Selection of Sources

The information search was conducted across recognized academic databases and digital repositories, including PubMed, SciELO, Google Scholar, and Scopus. Documents from official organizations, such as the World Health Organization and the Argentine Ministry of Health, were also consulted.

The following Spanish keywords were used: telemedicine, telehealth, primary care, COVID-19, and digital health. To expand the international search, the following MeSH terms were incorporated: telemedicine, primary care, digital health, and post-pandemic healthcare.

The inclusion criteria were: Articles published between 2019 and 2025 to ensure post-pandemic updates; Studies addressing the use of telemedicine in primary care or in rural and urban populations; and official documents and regulations governing telemedicine in Argentina.

The exclusion criteria were: Articles without full-text access; Duplicate publications across different databases; and Studies focusing exclusively on hospital-based telemedicine unrelated to primary care.

Organization and Analysis of the Information

Once the sources were selected, we read, classified, and summarized the most relevant content, identifying the main trends, benefits, and challenges reported. The information was organized thematically, grouping the findings into three categories:

Scope and benefits of telemedicine in primary care.

Technological, social, and regulatory limitations.

Prospects for sustainable integration into the healthcare system.

No statistical analysis was performed, as this study does not include original data but rather integrates findings from previously published studies.

4. Quality Assurance of the Information

To ensure reliability, peer-reviewed articles, official digital health guidelines, and current regulations were prioritized. References were cited in Vancouver style, allowing verification of each source.

RESULTS

The review included 15 articles published between 2021 and 2025 that analyzed the use of telemedicine in primary care across different geographic contexts. Three major thematic areas were identified: access and coverage; user and professional satisfaction and perceptions; and structural and regulatory limitations.

Regarding access to primary care, Chiliquinga and López (2025) demonstrated that telemedicine significantly improved coverage in rural areas of Ecuador, reducing wait times and travel costs. Similar results were reported by Mallma (2024), who highlighted the usefulness of teleconsultation in mitigating the shortage of healthcare professionals in remote areas. Likewise, Silva-Tinoco and Torre-Saldaña (2021) documented its effectiveness in the comprehensive management of patients with diabetes during the pandemic.

Regarding satisfaction and perceptions, Becerra-Martínez et al. (2024) reported high satisfaction among outpatient patients with telehealth during the COVID-19 pandemic, while Gomes-de Almeida et al. (2021) found moderate acceptance, highlighting convenience but also the difficulty of technological adaptation among older adults. In Spain, Loezar-Hernández et al. (2023) found that primary care midwives viewed the continuity of care via telemedicine positively, although they noted the need for further professional training.

In terms of regulations, Spinosa (2024) analyzed the Argentine legal framework, identifying gaps in bioethics and informed consent. Similarly, Eler et al. (2023) reported administrative and regulatory barriers in Peru that affect the sustainability of the service.

Regarding limitations, Conde (2024) showed that the perceived ease of use in Puerto Rico was conditioned by technological infrastructure and socioeconomic status. Carrillo et al. (2022) noted that the shift from in-person to virtual consultations initially generated mistrust among a part of the population. García Ron et al. (2022) reported that, while telemedicine was useful for pediatric emergencies, it did not completely replace in-person evaluation in complex cases.

Finally, prospective studies such as those by Vilaseca and Howe (2022) and Herrera et al. (2023) suggested that primary care in the future must integrate hybrid modalities to ensure equity and quality of care. Mazón-Ramos et al. (2023) demonstrated that implementing e-consultations between primary care physicians and cardiologists reduced unnecessary referrals, thereby optimizing resource use.

Below is a summary of the most relevant results in the table.

DISCUSSION

The results obtained in this review confirm that telemedicine is establishing itself as an effective strategy for expanding access to primary care, especially in rural settings and resource-poor communities. This finding is consistent with Chiliquinga and López, who show that coverage improves significantly in remote areas through virtual care, and aligns with Mallma, who highlights its role as a tool to address the shortage of healthcare personnel.

However, this review also reveals that telemedicine alone cannot eliminate preexisting inequalities. Conde and Eler demonstrate that poor technological infrastructure and low digital literacy are persistent barriers, reinforcing Vilaseca and Howe's point about the need for a hybrid model that combines in-person and virtual care. This aspect raises an important point: while telemedicine democratizes access, it can widen digital divides if not accompanied by inclusive policies.

In terms of acceptance, satisfaction levels are high, as shown by Becerra-Martínez and Loezar-Hernández, but nuances exist across populations. Older adults, as documented by Gomes-de Almeida, face greater difficulties in adapting, underscoring the need for targeted support strategies. Furthermore, García Ron highlights that, in pediatrics and complex cases, teleconsultation does not replace in-person evaluation, reaffirming that telemedicine should be understood as a complement rather than an absolute replacement.

From a regulatory perspective, Spinosa identifies legal gaps in bioethics and informed consent in Argentina, a problem also evident in other Latin American countries, according to Eler. These gaps influence the pace of adoption and raise ethical challenges that remain unresolved. This review highlights the simultaneous integration of technological, social, and regulatory dimensions, showing that its adoption depends not only on professional will but also on a robust regulatory and educational ecosystem.

As a methodological limitation, this review is narrative, which prevents the quantitative measurement of the magnitude of the identified benefits and barriers. However, it enables a comprehensive analysis of experiences across contexts, which is valuable for understanding the phenomenon holistically.

Looking ahead, it is necessary to investigate sustainable hybrid models that integrate telemedicine and in-person care, prioritizing digital equity and the training of both professionals and users. It is also essential to further develop ethical regulatory frameworks and assess the long-term impact on the quality of care and the doctor-patient relationship.

In Argentina, there are regulations governing telemedicine, such as Law 27,553, which establishes general guidelines for its practice, including the protection of personal data and the need to ensure the quality and safety of care.

Ministerial Resolutions: The Ministry of Health has issued various resolutions detailing specific aspects of telemedicine, including the regulation of platforms, electronic prescribing, and system integration.

National Telehealth Plans: Plans such as the 2018–2024 National Telehealth Plan have been developed to promote the development and integration of telehealth into the Argentine healthcare system.

In summary, this study reaffirms that telemedicine is a strategic tool for improving accessibility and optimizing resources in primary care. However, its sustainability and effectiveness depend on overcoming structural, regulatory, and cultural barriers that still limit its full development.

CONCLUSIONS

Overall, the analysis shows that telemedicine has transformed the delivery of primary care, becoming an indispensable complementary strategy in the post-pandemic period. Although it has proven effective in improving coverage, streamlining care processes, and optimizing resources, its full implementation requires overcoming technological, educational, and regulatory challenges that affect its equity and sustainability.

This study provides an integrated view of the benefits and limitations, highlighting the need to move toward hybrid models that strengthen the doctor-patient relationship and ensure quality of care. It is concluded that telemedicine should not be viewed as an end in itself, but rather as part of a resilient, flexible healthcare system adapted to new digital realities.

References

1. 1 Chá Ghiglia M. Telemedicina: su rol en las organizaciones de salud. Rev Méd Urug [Internet]. 2020 dic [citado día mes año];36(4):e185. Disponible en: http://www.scielo.edu.uy/scielo.php?pid=S1688-03902020000400185&script=sci_arttext
2. 2 Ruiz A, Zuluaga A, Trujillo. Telemedicina: introducción, aplicación y principios de desarrollo. Rev CES Med [Internet]. 2007 [citado día mes año];21(2):1-9. Disponible en: https://www.redalyc.org/pdf/2611/261120984009.pdf
3. 3 Vidal-Alaball E, Descals Singla E. Abordaje de la telemedicina entre proveedores: ejemplos de uso. Experiencias de telemedicina en la Catalunya Central. Elsevier [Internet]. 2021 dic [citado día mes año];3(4):e33. Disponible en: https://www.sciencedirect.com/science/article/pii/S260507302100033X
4. 4 Fernández Rodríguez G, Jiménez Galán F. Telemedicine and specialised consultations in prisons: the example of HCV chronic hepatitis. Rev Esp Sanid Penit [Internet]. 2019 [citado día mes año];21(2):59-65. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1575-06202019000200059
5. 5 Organización Mundial de la Salud. La OMS publica las primeras directrices sobre intervenciones de salud digital [Internet]. 2019 [citado día mes año]. Disponible en: https://www.who.int/es/news/item/17-04-2019-who-releases-first-guideline-on-digital-health-interventions
6. 6 Gobierno de la Ciudad de Buenos Aires. Telemedicina, el servicio por videollamada que salva vidas [Internet]. 2020 [citado día mes año]. Disponible en: https://buenosaires.gob.ar/salud/noticias/como-funciona-telemedicina-el-nuevo-servicio-medico-por-videollamada-del-same-que
7. 7 Chiliquinga JM, López OE. Impacto de la telemedicina en el acceso a atención primaria de salud en áreas rurales. Polo del Conocimiento. 2025;10(5):3048-68.
8. 8 Becerra-Martínez N, et al. Satisfacción con la atención mediante telesalud durante la pandemia de COVID-19 en pacientes ambulatorios. Rev Univ Ind Santander Salud. 2024;56.
9. 9 Conde BR. Utilidad y facilidad percibidas del uso de la telemedicina en Puerto Rico: el caso de la salud primaria en tiempos disruptivos [tesis doctoral]. Universidad Ana G. Méndez-Gurabo; 2024.
10. 10 Spinosa JC. Análisis del marco normativo argentino de telemedicina desde una perspectiva de bioética. 2024.
11. 11 Silva-Tinoco R, Torre-Saldaña V. La imperiosa necesidad de telemedicina en la atención de diabetes durante la pandemia de COVID-19. Gac Med Mex. 2021;157(3):323-6.
12. 12 Lovo J. Telemedicina: oportunidades en atención primaria. Rev Bras Med Fam Comunidade. 2021;16(43):2552.
13. 13 Loezar-Hernández M, et al. Percepciones de matronas de atención primaria sobre el uso de la telemedicina durante la pandemia COVID-19 en España. Enferm Clin. 2023;33(6):380-90.
14. 14 Gomes-de Almeida S, Marabujo T, do Carmo-Gonçalves M. Grado de satisfacción de los pacientes de la Unidad de Salud Familiar Vitrius con la teleconsulta durante la pandemia del COVID-19. Med Fam SEMERGEN. 2021;47(4):248-55.
15. 15 García Ron A, et al. Utilidad de la telemedicina en la atención pediátrica urgente durante la pandemia por COVID-19. Pediatr Aten Primaria. 2022;24(93):23-9.
16. 16 Vilaseca JM, Howe A. La atención primaria del futuro: ¿qué puede aprender la atención primaria europea de las innovaciones y retos de la pandemia de COVID-19? Aten Primaria Práctica. 2022;4:100163.
17. 17 Carrillo MJ, et al. Percepciones y experiencias de la población ante la transformación de la modalidad de las consultas en atención primaria durante la pandemia. Aten Primaria. 2022;54(4):102263.
18. 18 Mallma A. Eficacia y limitaciones de la telemedicina en la atención primaria rural: revisión sistemática de estrategias y desafíos. Prospect Univ Cienc Salud. 2024;5(2):5-13.
19. 19 Mazón-Ramos P, et al. Impacto de la pandemia por COVID-19 sobre un programa de consulta electrónica universal (e-consulta) entre médicos de atención primaria y cardiólogos. Rev Clin Esp. 2023;223(6):350-8.
20. 20 Eler BC, et al. Barreras en telemedicina de atención primaria de salud en tiempos de COVID-19, Huánuco, Perú. Rev Kasmera. 2023;51.
21. 21 Herrera AG, et al. Mayor uso de teleconsultas programadas y mensajería asincrónica del portal en atención primaria. 2023.
22. 22 Ambrosi E, Mezzalira E, Canzan F, Leardini C, Vita G, Marini G, et al. Effectiveness of digital health interventions for chronic conditions management in European primary care settings: Systematic review and meta-analysis. Int J Med Inform 2025;196:105820. https://doi.org/10.1016/j.ijmedinf.2025.105820..
23. 23 Andreadis K, Muellers K, Ancker JS, Horowitz C, Kaushal R, Lin JJ. Telemedicine Impact on the Patient-Provider Relationship in Primary Care During the COVID-19 Pandemic. Med Care 2023;61:S83–8. https://doi.org/10.1097/MLR.0000000000001808..
24. 24 Beheshti L, Kalankesh LR, Doshmangir L, Farahbakhsh M. Telehealth in Primary Health Care: A Scoping Review of the Literature. Perspect Health Inf Manag 2022;19:1n.
25. 25 Carrillo de Albornoz S, Sia K-L, Harris A. The effectiveness of teleconsultations in primary care: systematic review. Fam Pract 2022;39:168–82. https://doi.org/10.1093/fampra/cmab077..
26. 26 Keshet Y, Popper-Giveon A, Adar T. Telemedicine and time management in primary care. Fam Pract 2025;42:cmae051. https://doi.org/10.1093/fampra/cmae051..
27. 27 Mabeza RMS, Maynard K, Tarn DM. Influence of synchronous primary care telemedicine versus in-person visits on diabetes, hypertension, and hyperlipidemia outcomes: a systematic review. BMC Prim Care 2022;23:52. https://doi.org/10.1186/s12875-022-01662-6..
28. 28 Mascitti H, Duran C, Bouchand F, Haas L, Rodhe A, Cauterman M, et al. Infectious diseases and primary care telemedicine in France. Infect Dis Now 2022;52:236–8. https://doi.org/10.1016/j.idnow.2022.03.005..
29. 29 Pagliari C. Digital health and primary care: Past, pandemic and prospects. J Glob Health 2021;11:01005. https://doi.org/10.7189/jogh.11.01005..
30. 30 Reed M, Huang J, Somers M, Hsueh L, Graetz I, Millman A, et al. Telemedicine Versus In-Person Primary Care: Treatment and Follow-up Visits. Ann Intern Med 2023;176:1349–57. https://doi.org/10.7326/M23-1335..
31. 31 Schweiberger K, Verma R, Faulds S, Jonassaint CR, White GE, Ray KN. Scheduled and attended pediatric primary care telemedicine appointments during COVID-19. Pediatr Res 2023;94:185–92. https://doi.org/10.1038/s41390-023-02481-w..