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Objective This study aimed to estimate reductions in travel-related carbon dioxide (CO₂) emissions, travel time and distance resulting from a telemedicine service for patients with chronic conditions, and to assess its potential to contribute to more equitable access to specialised care in Northeast Brazil.Design Cross-sectional study.Setting Primary healthcare units in the Northeast region of Brazil.Participants Patients between birth and 104 years of age with chronic conditions who received video-based teleconsultations between June 2022 and November 2023.Primary and secondary outcome measures The primary outcome was the reduction in travel-related carbon emissions due to avoided in-person referrals. Secondary outcomes included travel time and travel distance savings. Round-trip distances between primary healthcare units and referral centres were estimated using geolocation data. CO₂ emissions were calculated using the Greenhouse Gas (GHG) Protocol adapted to Brazil (Brazilian GHG Protocol Programme), focusing on Scope 3 emissions from patient travel.Results A total of 4642 teleconsultations were conducted with 4106 patients. Of these, 4021 (86.6%) avoided in-person referrals, resulting in estimated savings of 226 900 miles in travel distance and 488 584 min in travel time. The estimated CO₂ emissions avoided totalled 21 593 kg (21 930 kg CO₂ equivalent), with a mean of 5.37 kg (SD±5.5) per teleconsultation (5.4 kg CO₂ equivalent ; SD±5.5). Greater travel distance savings were observed among patients living in municipalities with lower Municipal Human Development Index (mean 92.3±104.2 miles vs 17.3±8.4 miles; p<0.001) and populations under 50 000 inhabitants (mean 64.6±84.9 miles vs 17.3±29.6 miles; p<0.001).Conclusions Telemedicine use in Northeast Brazil significantly reduced patient travel, leading to substantial savings in CO 2 emissions. These savings were more pronounced for patients in smaller, less developed municipalities. By reducing the need for travel, telemedicine can improve access to healthcare for remote or underserved populations, while also supporting environmental sustainability.