Chronic diseases require continuous, patient-centred care, yet access to follow-up is often limited by organisational and social barriers. Telemedicine is promoted as a tool to improve continuity and equity of care, but real-life evidence from pathways involving community and primary care physicians is limited. At the AOU Policlinico Umberto I (Rome), a Day Service of predictive, gender-specific medicine and chronicity coordinates an integrated pathway for adult chronic diseases in collaboration with community and primary care medicine, using video consultations for follow-up.To evaluate feasibility, acceptability and perceived impact of this telemedicine pathway for adults with chronic conditions, and to identify factors associated with digital difficulties.We conducted a prospective cohort including adults with metabolic syndrome, diabetes mellitus, osteoporosis, arterial hypertension, asthma, COPD and long-Covid followed through scheduled televisits between September 2023 and July 2024. Clinical and organisational data were collected, together with Patient-Reported Experience Measures (PREMs). Difficulties in using the technology were analysed by age group and presence of caregiver support.A total of 120 televisits were performed. Telemedicine was highly accepted: 96% of patients expressed willingness to continue and 97% did not require an additional in-person visit. PREMs showed high satisfaction: 76% of patients felt more confident in managing their condition, and over 90% perceived improved symptom control and a better relationship with their physician. Technological difficulties were concentrated among patients over 60 years without caregiver support, who had a significantly higher risk of problems in connecting and interacting online.Telemedicine within an integrated chronic care pathway can strengthen patient empowerment, continuity of care and the therapeutic alliance, while reducing potentially avoidable face-to-face visits. At the same time, age-related digital divides and lack of family or community support may limit access for the most vulnerable, risking new inequities.Telemedicine appears to be an effective and well-accepted tool for chronic disease management in a Primary Care–Community Medicine context. Scaling up such models requires investment in digital literacy, technical support and structured links with territorial services, in line with national and regional policies, so that telemedicine promotes equity and humanism in primary health care.