JMIR Publications

ABSTRACT

Background:

Despite the increasing availability of digital health technologies, clinical engagement remains minimal.

Objective:

To identify and weight barriers to, and drivers of digital health prescribing amongst a representative sample of healthcare professionals from the United Kingdom.

Methods:

A discrete-choice experiment was conducted with 222 healthcare professionals (HCPs) using an online survey between March-2019 and June-2019. Participants were recruited to take part via social media; and asked to choose their preferred option of 2 hypothetical digital health technologies (DHTs) to prescribe to a hypothetical patient, or to ‘prescribe neither’. Choices were characterised by differing levels of patient age, cost, published evidence bases, whether they had an NHS stamp of approval, personal familiarity with the technology and whether they came recommended by a fellow HCP. Results were analysed using a mixed-logit model, with subgroup analyses to account for heterogeneity.

Results:

96.5% of respondents understood the survey task and passed the test of rationality. All attributes were statistically different from zero, indicating importance to HCPs with respect to digital health prescribing. DHTs were most likely to be prescribed to patients if they had an NHS stamp of approval or if they came recommended by another HCP. Published studies were important, but it would take 5 published studies to have the same impact on prescribing behaviour as an NHS stamp of approval, and 2 studies to be as convincing as having used the technology personally. Increasing patient age and costs resulted in significant reductions in digital health prescribing. Willingness-to-pay for DHTs increased by £124.61 if an NHS stamp of approval was present and by £29.20 for each published study. 8% of respondents were ‘digitally hesitant’, always choosing the ‘I would prescribe neither’ option; particularly so among older HCPs, nurses, and those who do not use DHTs personally. Sub-group analyses revealed differences in preferences amongst HCPs of differing age and clinical backgrounds.

Conclusions:

An NHS stamp of approval, published studies, and recommendations from fellow HCPs are significant facilitators of digital prescribing; while increasing costs and patient age are significant barriers to engagement. These findings suggest that demonstrating assurances of DHTs and supporting both the dissemination and peer-to-peer recommendation of evidence-based technologies are critical if the NHS is to achieve its long-term digital transformation ambitions.