Digital Facilitation to Support Patient Access to Web-Based Primary Care Services: Scoping Literature Review

Abstract

Background The use of web-based services within primary care (PC) in the National Health Service in England is increasing, with medically underserved populations being less likely to engage with web-based services than other patient groups. Digital facilitation—referring to a range of processes, procedures, and personnel that seek to support patients in the uptake and use of web-based services—may be a way of addressing these challenges. However, the models and impact of digital facilitation currently in use are unclear. Objective This study aimed to identify, characterize, and differentiate between different approaches to digital facilitation in PC; establish what is known about the effectiveness of different approaches; and understand the enablers of digital facilitation. Methods Adopting scoping review methodology, we searched academic databases (PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library) and gray literature published between 2015 and 2020. We conducted snowball searches of reference lists of included articles and articles identified during screening as relevant to digital facilitation, but which did not meet the inclusion criteria because of article type restrictions. Titles and abstracts were independently screened by 2 reviewers. Data from eligible studies were analyzed using a narrative synthesis approach. Results A total of 85 publications were included. Most (71/85, 84%) were concerned with digital facilitation approaches targeted at patients (promotion of services, training patients to improve their technical skills, or other guidance and support). Further identified approaches targeted PC staff to help patients (eg, improving staff knowledge of web-based services and enhancing their technical or communication skills). Qualitative evidence suggests that some digital facilitation may be effective in promoting the uptake and use of web-based services by patients (eg, recommendation of web-based services by practice staff and coaching). We found little evidence that providing patients with initial assistance in registering for or accessing web-based services leads to increased long-term use. Few studies have addressed the effects of digital facilitation on health care inequalities. Those that addressed this suggested that providing technical training for patients could be effective, at least in part, in reducing inequalities, although not entirely. Factors affecting the success of digital facilitation include perceptions of the usefulness of the web-based service, trust in the service, patients’ trust in providers, the capacity of PC staff, guidelines or regulations supporting facilitation efforts, and staff buy-in and motivation. Conclusions Digital facilitation has the potential to increase the uptake and use of web-based services by PC patients. Understanding the approaches that are most effective and cost-effective, for whom, and under what circumstances requires further research, including rigorous evaluations of longer-term impacts. As efforts continue to increase the use of web-based services in PC in England and elsewhere, we offer an early typology to inform conceptual development and evaluations. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020189019; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019

What helps patients access web-based services in primary care? Free-text analysis of patient responses to the Di-Facto questionnaire

“…A recent systematic review of approaches to digital facilitation in primary care suggests that low knowledge of which web-based services are available is a significant barrier to their use in primary care [ 9 ]. Training and education, for instance, through web-based videos or in-person seminars, may promote the uptake and use of digital services [ 9 ].…”

“…A recent systematic review of approaches to digital facilitation in primary care suggests that low knowledge of which web-based services are available is a significant barrier to their use in primary care [ 9 ]. Training and education, for instance, through web-based videos or in-person seminars, may promote the uptake and use of digital services [ 9 ]. Some of the respondents in our study described needing support to access online services, and previous research has suggested that patient-centred guidance and practice champions as ‘experts’ may increase initial uptake or support continued use of web-based services [ 13 , 14 ].…”

“…The Di-Facto patient questionnaire was developed iteratively over a series of meetings with the research team and the project’s patient advisory group (PAG) and was informed by previous research and the findings of a literature review [ 9 ]. The questionnaire included a total of 30 questions including the two free-text questions, and focussed on online services offered from the respondent’s GP practice and how helpful any support was from the practice [ 8 ].…”

Proof of Concept of Telemedicine-Assisted Abdominal Ultrasound Examinations to Improve the Quality of Patient Care in Rural Areas

“…Digital health techniques can reduce inequalities in access to health care and allow health care centers at different levels of care to co-operate for better and effective health care management of patients [ 20 , 27 ]. This study might help to clarify whether telemedicine-assisted ultrasound by a qualified expert is non-inferior to in-presence sonography (by a qualified expert) concerning clinical success.…”

Digital Facilitation to Support Patient Access to Web-Based Primary Care Services: Scoping Literature Review (Preprint)

“…The scoping review was conducted in stages (Figure 1) to allow learning from earlier stages to be fed into later stages. The protocol for the study was registered with PROSPERO (International Prospective Register of Systematic Reviews; registration number CRD42020189019) [25].…”