JMIR Publications

ABSTRACT

Background:

Digital transformation of primary care practices, including the use digital health interventions (DHIs), has yet to be systematically evaluated.

Objective:

To identify and describe the scope and use of current DHIs for preventive care in primary care settings.

Methods:

A scoping review to identify literature published from 2014 to 2020 was conducted across multiple databases using keywords and MeSH terms covering primary care professionals AND prevention and care management AND digital health. A subgroup analysis identified relevant studies conducted in US primary care settings excluding DHIs that use the electronic health record (EHR) as a retrospective data capture tool. Technology descriptions, outcomes (e.g., healthcare performance and implementation science), and study quality as per Oxford Levels of Evidence were abstracted.

Results:

The search yielded 5,274 citations of which 1,060 full-texts were identified. Following a subgroup analysis, 241 articles met inclusion criteria. Studies primarily examined DHIs among health information technology including EHRs (69%), clinical decision support (41%), telehealth (37%), or multiple technologies (61%). DHIs were predominantly used for tertiary prevention (55%). Of the core primary care functions, comprehensiveness was addressed most frequently (87%). DHI users were providers (85%), patients (46%), or multiples (37%). Reported outcomes were primarily clinical (70%) and statistically significant improvements were common (69%). Results were summarized across five topics for the most novel/distinct DHIs: population-centered, patient-centered, care access expansion, panel-centered (dashboarding), and application-driven DHIs. Quality of the included studies was moderate-to-low.

Conclusions:

Preventive DHIs used in primary care settings demonstrated meaningful improvements in both clinical and non-clinical outcomes across user types; however, adoption and implementation in the US was limited to primarily electronic health record-centric platforms and users were mainly clinicians receiving alerts regarding care management for their patients. Evaluation of negative results, effects on health disparities, and many other gaps remain to be explored.