JMIR Publications

ABSTRACT

Background:

Health service policy in England, and elsewhere, is driving greater investment into the use of digital primary care services. Whilst there are benefits for some patients and practices, there are also concerns that not all are able or wish to access primary care services online. ‘Digital facilitation’, which we define as ‘the range of processes, procedures, and personnel which seeks to support NHS patients in their uptake and use of online services’, may provide a way to address such concerns.

Objective:

As part of a multi-method programme of research, we undertook surveys of practice staff and of patients to gain insight into what support, if any, was being offered by practices, and to explore patients’ experiences of that support.

Methods:

General practices randomly selected from four regions of England were sent a questionnaire exploring the modes of digital facilitation offered, who was involved in its delivery, and views on the motivations and drivers for providing support. 12,822 patients registered with 62 general practices (predominantly those responding to the practice survey) were sent a questionnaire exploring their experiences of any support offered by their practice to use online services.

Results:

156/500 practices (31%) responded to the practice survey, with most reporting using passive modes of digital facilitation (e.g. display, leaflets, text messages) and very few using active modes (e.g. offering tablets/computer, use of practice champions). However, 91% reported providing ad hoc support. Practices agreed it was the responsibility of both the practice (73% of practices) and the wider NHS (83%) to support patients in using online services, and that providing such support benefitted the practice (88%) and their patients (92%). 3,051 patients (23.8%) responded to the patient survey, with few reporting awareness of any modes of digital facilitation (≤17%) apart from texts messages/emails (39%), and only 13% reporting receiving support to use online services. Adjusted logistic regression analyses showed that older patients had a lower likelihood of: being aware of or of using digital facilitation efforts, or being told about or being helped to use online services, P<0.05 for all) particularly with regards to being helped to use online services (adjusted OR ≥ 85 versus 55-64 year old 0.08, 95%CI 0.02-0.36). In contrast, participants of non-white ethnicity, or those for whom their first language was not English, had positive associations with these four outcomes.

Conclusions:

General practices recognize that patients would benefit from support to access their online services. However the support provided is often passive or ad hoc, and patients are seldom aware of the digital facilitation efforts that their practice provided. There is potential to increase engagement with online primary care services by providing more support to all patients, but particularly to provide targeted support for older patients. Clinical Trial: researchregistry6523 [https://www.researchregistry.com/browse-the-registry#home/?view_2_search=Di-Facto&view_2_page=1]