JMIR Publications

ABSTRACT

Background:

The Inverse Care Law stipulates that healthcare resources are unevenly distributed and tend to vary inversely with actual clinical needs. Hybrid approaches, which deliberately combine in-person and virtual care, may help counteract this phenomenon in various settings, including rural healthcare, by leveraging clinician capacity across geographic regions. However, the literature on the potential of hybrid approaches to primary care has not been comprehensively mapped.

Objective:

This scoping review aimed to map the international evidence on applications of the hybrid approach to primary care and examine its impacts across the domains of the Quadruple Aim framework for quality improvement.

Methods:

We conducted a scoping review following the PRISMA extension for Scoping Reviews and the five-stage framework by Levac et al. MEDLINE, Scopus, Embase, and CINAHL were searched for studies published from 2020 onward, supplemented by a grey literature search. We included literature describing hybrid approaches to outpatient care involving primary care clinicians. Outcomes were mapped across the Quadruple Aim domains of patient experience, clinician and non-clinical staff experience, clinical impact, and economic impact.

Results:

Of 3,504 unique records screened, 24 peer-reviewed studies and 8 grey literature sources were included. Peer-reviewed studies were predominantly conducted in North America (16/24) and in rural or remote settings (15/24). Hybrid approaches varied considerably in design and implementation but commonly used virtual-first models and interdisciplinary teams combining off-site physicians with locally based clinicians. Clinical impact was the most frequently assessed domain (13/24) and showed the most consistently favourable findings (11/13), followed by patient experience (6/8 studies reporting favourable findings). Clinician experience showed mixed findings, while economic impact was infrequently evaluated.

Conclusions:

Hybrid approaches show promise as an innovative way to address gaps in healthcare access and mitigate workforce maldistribution in hard-to-serve regions, with reported benefits spanning multiple domains of the Quadruple Aim. However, evidence regarding economic impact remains limited, highlighting an important area for future research. Clinical Trial: NA