JMIR Publications

ABSTRACT

Background:

Digital health is a growing field, and many digital interventions have been implemented on a large scale since the COVID-19 pandemic, mainly in primary healthcare (PHC). The development of digital health interventions and their application in PHC are encouraged by the World Health Organization. The increased number of published scientific papers on this topic has resulted in an overwhelming amount of information, but there is no overview of reviews to summarize this evidence.

Objective:

This study aims to provide policymakers, health managers, and researchers with a summary of evidence on digital interventions used in PHC.

Methods:

This overview of reviews searched the Web of Science and Medline databases for systematic and scoping reviews on assessments of digital technologies implemented in PHC, published from 2007 to March 2023. Only reviews that addressed digital interventions whose targets were real patients or healthcare professionals were included.

Results:

236 records were identified from the search strategy, of which 42 full-text papers were selected for analysis, and 18 reviews met eligibility criteria. Eleven reviews focused their analysis on specific digital health interventions (client-to-provider telemedicine; provider-to-provider telemedicine; health worker decision support systems; tracking patients’ health status systems; client participation and self-care platforms; provision of education and training to health workers), seven reviews focused on specific topics related to PHC (preventive care; chronic disease management; behavioral health disorders; the Covid-19 pandemic; multicomponent PHC interventions; care coordination). Most studies in the included reviews agreed on barriers to implementation, such as software and applications developed without involving end users, the lack of training of healthcare professionals and patients in digital technology use, and the lack of reimbursement and billing strategies for remote consultations. However, they showed several mixed results related to health service quality and patients’ clinical conditions and behavioral changes.

Conclusions:

Research in digital health applied to PHC is still concentrated in developed countries, mainly in North America and Europe. The mixed results related to health service quality and patients’ clinical conditions, or patients’ behavioral changes may have been caused by deficiencies in the process of implementing digital interventions. It is necessary to examine the entire impact pathway and the causal assumption between implementation, health services quality, and clinical conditions outcomes, to support the spread of digital health in PHC settings.