JMIR Publications

ABSTRACT

Background:

Digital health technologies, including telemedicine, electronic medical records (EMRs), digital health tools (DHTs), and artificial intelligence (AI), are transforming European primary care, but evidence on how general practitioners (GPs) experience these tools remains fragmented.

Objective:

To synthesize European GPs’ perspectives on the adoption and implementation of digital health technologies, focusing on perceived usefulness, ease of use, implementation barriers, workload, and doctor–patient relationships.

Methods:

We conducted a systematic review following PRISMA 2020 and SWiM guidance. Eight databases, PubMed, Scopus, SpringerLink, Wiley Online Library, Cochrane Library, Web of Science, Google Scholar, Ovid, and Elicit AI were searched for primary studies on GPs’ perspectives in European primary care, published in English or German between January 2014 and December 2024; a search update extended coverage to October 2025. Eligible qualitative, quantitative, and mixed methods studies reported GP perceived adoption, implementation, or impact of digital tools. Risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT) and JBI critical appraisal tools. Data were synthesized using Popay et al.’s narrative synthesis framework and a combined Technology Acceptance Model (TAM) and Normalization Process Theory (NPT) effect direction approach. The protocol was registered on the Open Science Framework (OSF) (registration 10.17605/OSF.IO/KE25C). The review received no dedicated external funding.

Results:

Of 1,580 references, 65 studies including 24,994 GPs across 14 European countries (93.8% from Western and Northern Europe) met the inclusion criteria. Studies covered AI or clinical decision support (n=7), DHTs (n=36), EMRs (n=4), and telemedicine (n=18). Perceived usefulness was high (86.2% positive), whereas perceived ease of use was universally poor (0% positive; 66.2% negative), while actual use remained near universal (96.9%). NPT constructs showed partial normalization: coherence 50.8% positive; cognitive participation 4.6% positive (33.9% negative); collective action 100% partial; reflexive monitoring 66.2% positive. Cross‑cutting barriers included poor interoperability, fragmented platforms, limited training, misaligned incentives, and unreimbursed digital workload, so digital tools tended to add rather than replace documentation tasks. GPs reported improved access for some patient groups but concerns about depersonalized care and digital exclusion among older, low‑literacy, rural, and socioeconomically disadvantaged patients.

Conclusions:

European general practice is extensively digitized but only partially normalized. GPs use digital tools because they must, not because they find them easy or workflow-enhancing. This review is, to our knowledge, the first to systematically synthesize European GPs’ experiences of digitalization across multiple technologies (EHRs, telemedicine, DHTs, and AI) using a combined TAM–NPT effect‑direction approach. It identifies a quantifiable “implementation paradox” in which high perceived usefulness and near‑universal use coexist with poor usability and only partial workflow integration, extending prior reviews that focused mainly on patient outcomes or on single tools. These findings highlight the need for interoperable, user‑centered systems that replace rather than add tasks, reimbursement of digital workload, structured digital‑competency training, and governance frameworks that safeguard equity and the quality of remote care in everyday general practice.