Exeter Collaboration for Academic Primary Care, College of Medicine and Health, University of Exeter, Exeter, UK.
BMC Prim Care. 2024 Jan 10;25(1):20. doi: 10.1186/s12875-023-02257-5.
The National Health Service (NHS) and general practice are increasingly adopting digital services. These services can impact both positively and negatively upon patient experiences, and access to digital services is not equal amongst all groups. Within a wider project examining digital facilitation (the Di-Facto study) our team conducted a patient survey amongst English primary care practices aiming to investigate patient views of what supports uptake and use of web-based services. This paper reports on the analysis of the free-text responses from the patient survey.
The Di-Facto patient survey was distributed to practices in eight clinical commissioning groups (CCGs) in England between 2021-2022. We examined free-text responses to two questions relating to access to primary care web-based and support for web-based services. We used qualitative reflexive thematic analysis based on a six-stage process to analyse responses.
Of the 3051 patients who responded to the Di-Facto survey, 2246 provided a free-text response. We present our findings in two major themes: systems and structures and their impact on use of web-based services, and 'what works for me', a description of how respondents described what worked, or did not work in terms of their interactions with web-based services. Respondents described how the technology, such as poor practice website design, confusion over multiple digital apps, data security and concerns about eConsultation offerings impacted on use of web-based services. Respondents described practice level barriers, such as a lack of or inconsistent provision, which prevented optimal use of web-based services. Respondents described personal and technical barriers that impacted on their use of digital services, and described which web-based services worked well for them. Respondents felt that web-based services were not a replacement for face-to-face interactions with a doctor.
This analysis of free-text responses from a large patient survey highlights the system, practice, and person level barriers and facilitators to use of digital services in primary care. With an increasing push towards digital solutions in NHS primary care, practices should consider the design, rollout and communication of their web-based services to support patient access.
国民保健制度（NHS）和全科医生越来越多地采用数字服务。这些服务可能对患者体验产生积极和消极的影响，而且并非所有群体都能平等获得数字服务。在一个更广泛的研究数字促进因素（Di-Facto 研究）的项目中，我们的团队在英格兰的一些初级保健诊所进行了一项患者调查，旨在调查患者对支持基于网络的服务采用和使用的看法。本文报告了对患者调查中自由文本回复的分析结果。
Di-Facto 患者调查于 2021 年至 2022 年期间在英格兰的八个临床委员会（CCG）的诊所中进行。我们分析了与初级保健网络服务获取和网络服务支持相关的两个问题的自由文本回复。我们使用基于六阶段过程的定性反思性主题分析方法来分析回复。
在回应 Di-Facto 调查的 3051 名患者中，有 2246 名提供了自由文本回复。我们将发现总结为两个主要主题：系统和结构及其对基于网络的服务使用的影响，以及“对我有效的方法”，描述了受访者如何描述他们与基于网络的服务交互时有效的方法，或无效的方法。受访者描述了技术，如糟糕的实践网站设计、对多个数字应用程序的混淆、数据安全以及对电子咨询产品的担忧，如何影响基于网络的服务的使用。受访者描述了实践层面的障碍，如缺乏或不一致的服务提供，这阻碍了基于网络的服务的最佳使用。受访者描述了个人和技术障碍，这些障碍影响了他们对数字服务的使用，并描述了哪些基于网络的服务对他们有效。受访者认为基于网络的服务不能替代与医生的面对面互动。
对来自大型患者调查的自由文本回复的分析突出了初级保健中使用数字服务的系统、实践和个人层面的障碍和促进因素。随着国民保健制度初级保健中对数字解决方案的推动，实践应该考虑他们的基于网络的服务的设计、推出和沟通，以支持患者的获取。
