Digital primary care visits designed for different patient segments in the pre-pandemic era: A scoping review

Digital healthcare services have been implemented increasingly during and after the COVID-19 pandemic. They have been expected to improve access, reduce inefficiencies, improve the quality of care, lower the cost of healthcare, and provide more personalised care. This study focuses on digital visits: digital health care services that replace a general practitioner (GP) appointment in primary care. The aim of this review is to assess the perspectives used in studying digital visits, and to describe the services studied in terms of modalities used and patient segments targeted. We aim to find how digital visits were studied prior to their becoming a necessity during the COVID-19 pandemic. This is a scoping review of English language papers published between 1.1.2010-31.5.2020. The papers were eligible for the review if they focused on a digital primary care visit which replaced a face-to-face appointment with a GP. In total, 36 papers were included. Ten of the studies described services tailored to the needs of a patient segment. The rest of the studies (26/36) did not differentiate between patient segments. The most often-used perspective was that of the clinician (16/36 studies). Fifteen studies were descriptive. The costs and outcomes were rarely utilised as a perspective: the costs were used in only one study and outcomes in six. Patient experience was the perspective chosen in 11 studies. Among all the interventions, the most common modality was by phone call (20), and the second most common was asynchronous messaging and video consultation (10 each). Prior to the COVID-19 pandemic, digital visits had mostly been developed for the entire population instead of a particular segment of patients. We argue that developing them to fit the needs of a patient segment would help make them more acceptable and suitable for patients. More studies from the patient perspective are needed to develop these services to better fit the needs of patients. The situation is likely to have changed during the pandemic, as a large number of studies has been published since May 2020

Digitaalisten palvelujen vaikutukset sosiaali- ja terveydenhuollossa

Selvityksen tavoitteena oli luoda ajantasainen kuva digipalvelujen vaikutuksista sosiaali- ja terveydenhuollossa eri toimijoiden näkökulmista. Digipalveluja hyödynnetään etenkin terveydenhuollossa, erityisesti avosairaanhoidossa asiakaspolun eri vaiheissa. Myös kotihoidossa digipalveluita hyödynnetään runsaasti. Muissa sosiaalihuollon palveluissa digipalveluja havaittiin vähemmän, erityisesti vammais- ja hoivapalveluissa. Sosiaalihuollon digipalvelut ovat myös enemmän pistemäisiä; sähköisiä hakemuksia ja lomakkeita. Digipalvelujen käyttäjät ovat pääosin tyytyväisiä palveluihin. Asiakkaille kriittistä on digipalvelujen saavutettavuus ja integraatio, etenkin jos henkilöllä on useita pitkäaikaisia sairauksia, vammoja tai toiminnanvajausta. Ammattilaisten kokemukset digipalveluista ovat osin positiivisia, mutta huolia työmäärän lisääntymisestä esiintyy. Käyttöönotoissa tulisi tehdä enemmän työtä digipalvelujen viimekätisten hyötyjen ja vaikutusten saavuttamiseksi. Palvelujärjestelmän johto kokee, että digipalvelujen vaikutusten ja vaikuttavuuden arviointia tulisi lisätä, mutta mittaaminen on haasteellista. Yksi ratkaisu on sitoa mittaaminen voimakkaammin tavoitteisiin, mikä edellyttäisi selkeämpää tavoiteasetantaa. Digipalvelujen vaikuttavuus ei juurikaan näy lainsäädännössä, ja lainsäädännössä on useita kehittämistarpeita. Lain tulkinnat aiheuttavat haasteita digipalvelujen käytölle.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa. (tietokayttoon.fi) Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Impact of digital services on healthcare and social welfare : An umbrella review

Background: Digital services can be effective and cost-efficient options for treating non -communicable diseases, but generalizability is limited due to heterogeneous treatment effects. This umbrella review aims to evaluate the impact of digital services on population health, costs, and patient and healthcare professional satisfaction, and to identify facilitators and barriers to using digital services in healthcare and social welfare. Methods: The protocol of the study was registered on the 4th of September 2022 to the International Prospective Register of Systematic Reviews, PROSPERO (CRD42022355635). The review was performed using the Centre for Reviews and Dissemination, Cochrane, Ovid Medline, Scopus, and Web of Science in June 2022. The methodological quality of the included reviews was assessed. The impact of digital services was categorized as no evidence, no dominance, and mixed and positive effect. Inductive content analysis was used to identify facilitators and barriers. Results: A total of 66 studies were included in the review, 64 % of which were evaluated as high quality. Studies on the impact of digital services in social welfare were not identified. Sixty-five percent of reviews evaluated the impact of digital services on population health with mixed effects; 21 % were on costs with mixed effects; 27 % were on patient satisfaction with positive effects; and 7.6 % were on healthcare professionals' satisfaction with mixed effects. Various features, allocation, end -user support, organized services, and service development facilitated the use of digital services. Correspondingly, barriers were related to service limitations, digital competency, fundingand service strategies, resources and change management. Conclusions: Compared to usual care, digital services had a mixed impact on population health and costs with high satisfaction in patients. Mixed healthcare professionals' satisfaction was associated with the use of digital services, and it was less studied. To ensure successful implementation and sustainability of digital services, attention must be paid to address barriers and supporting facilitators at all levels. (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Peer reviewe