JMIR Publications

ABSTRACT

Background:

General Medical Practitioners (GPs) and other staff at primary care medical practices have an important role in facilitating patient access to online services in the National Health Service (NHS) in England. These services range from online ordering of repeat prescriptions to conducting online consultations with healthcare professionals. We have defined ‘digital facilitation’ as that range of processes, procedures and personnel which seeks to support patients in their uptake and use of online services.

Objective:

We report how we have synthesised the evidence from a mixed methods study of digital facilitation in primary care in England. The study's objectives were: to identify, characterise and explore the benefits and challenges of different models of digital facilitation in general medical practices in England; and to design a framework for evaluation of the effectiveness and cost-effectiveness of digital facilitation interventions.

Methods:

Our study comprised: scoping review of literature; survey of staff in general practices; survey of patients; and ethnography at case study practices plus stakeholder interviews. We compiled a triangulation matrix of the findings from individual work packages through an iterative process whereby each work package’s results were first analysed separately and were then cumulatively combined across work packages in three successive workshops. From the resulting matrix we developed a programme theory and an implementation theory, and constructed a framework for evaluations of digital facilitation in primary care. The final step of the synthesis process was to discuss the results with national and regional NHS stakeholders.

Results:

Triangulation yielded a combined set of findings summarised within 11 thematic groupings: three setting the scene within which digital facilitation takes place, and eight related to different types of digital facilitation, their implementation and effectiveness. Some thematic groupings were evident in the findings of all four of the research work packages; others were not addressed in all the work packages but were evident from those where they were addressed. Throughout the synthesis work, there were no instances where findings from one work package contradicted the findings of another. Findings either reinforced each other or offered complementary or additional insights. The discussion at the stakeholder meeting held at the end of the study resulted in the research team clarifying some findings, but not changing any of them.

Conclusions:

Digital facilitation can take many forms, though much of what is currently done in primary care practices in England is reactive and passive. Clear lines of responsibility, digital tools and platforms that work well for patients and practice staff, and investment in staff time and training, are all needed if digital facilitation is to deliver on its promise. We propose a framework for future evaluations of the effectiveness and cost-effectiveness of digital facilitation interventions.