JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic had an unprecedented impact on the delivery of healthcare, with digital interventions accelerating more than ever before. However, evidence of how hybrid care models were implemented during the pandemic remains scattered. Understanding hybrid models of care is imperative to build resilient health systems that can adapt to emergency situations and ensure access to care.

Objective:

The main objective was to examine the implementation of hybrid care modifications to support the delivery of non-pandemic healthcare services in Europe during the COVID-19 pandemic, including the telehealth systems used and their functionalities, and how they were integrated into hybrid models of care.

Methods:

A scoping review was conducted following PRISMA-ScR guidelines and covering five electronic databases. Studies were eligible if they described digital care modifications implemented or scaled up during the COVID-19 pandemic for the delivery of non-pandemic healthcare services in Europe. Quality appraisal was conducted following the Mixed Methods Appraisal Tool (MMAT). Hybrid implementation of care modifications was recorded. Descriptions of digital care modifications were used to create digital flows, describing telehealth systems, digital interventions, and care functions. Study evaluations of care modifications were extracted following the Kirkpatrick model.

Results:

A total of 5877 distinct studies were identified through the search, and 163 studies were included for analysis. Studies covered evidence from 2020 to 2024, 20 countries, and 34 healthcare disciplines. Hybrid care implementation was reported in over 60% of the studies, describing a variety in forms of digital and in-person care. Prominent digital flows included the use of online platforms to support video and messaging for follow-up care. Over half of the studies did not describe any kind of evaluation.

Conclusions:

The creation of digital flows revealed the various ways digital health technologies were implemented during the pandemic, with few telehealth systems facilitating the application of numerous interventions and care functions. Incorporating digital care as part of hybrid care models is essential in designing future care pathways that can adapt to different contexts, including health emergency situations.