What is the potential for digital facilitation to support patient access to online primary care service? A scoping literature review

Problem

Amidst efforts to get more primary care (PC) patients to use online services, evidence suggests slow and uneven uptake with medically underserved populations less likely to engage with online services. PC practices may be able to support the use of online services and address their potential contribution to inequalities through ‘digital facilitation’ (DF), or ‘that range of processes, procedures, and personnel which seeks to support NHS patients in their uptake and use of online services.’ However, the models and impact of DF currently in use are unclear.

Approach

We conducted a scoping review of the literature to understand the potential for DF to support patient use of online services. We searched academic databases (PubMed, Embase, CINAHL, Web of Science and the Cochrane Library) and grey literature (published 2015-2020). We conducted snowballing searches of reference lists of included articles and articles identified during screening as relevant to digital facilitation, but which did not meet inclusion criteria due to article type restrictions. Titles and abstracts were independently screened by two reviewers. Data from eligible studies were analysed by four researchers using a narrative synthesis approach.

Findings

We screened 12,277 records plus the reference lists of 74 articles resulting in 89 included publications. We found that DF included approaches aimed at training PC staff to help patients (e.g. improving staff’s knowledge of online services; enhancing their technical or communication skills), and those aimed directly at patients: promotion of services, training patients to improve their technical skills, or other guidance and support. Our review identified few rigorous evaluations of DF approaches. However, qualitative evidence suggests that some forms of DF may be effective at promoting uptake and use of online services (e.g. recommendation of online services by practice staff; coaching). We found little evidence that providing patients with initial assistance in registering for or accessing online services would lead to increased long-term use. Few studies addressed the effect of DF on healthcare inequalities. Those that did suggested that providing technical training for patients could be an effective approach for reducing inequalities, although no approach was shown to fully overcome intergroup disparities. We found no studies assessing the cost-effectiveness of DF. Factors affecting the success of DF include: perceptions of the usefulness of the online service, trust in the service, patients’ trust in providers, capacity of primary care staff, guidelines or regulations supporting facilitation efforts, and staff buy-in and motivation.

Consequences

Evidence from our review suggests that digital facilitation has the potential to increase the uptake and use of online services by PC patients, but that to understand which approaches are most effective and cost-effective, for whom, and under what circumstances, further research that includes rigorous evaluations of the approaches identified by our scoping review are required.