Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK.
Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Gibbet Hill, UK.
Health Soc Care Deliv Res. 2024 Sep;12(32):1-197. doi: 10.3310/JKYT5803.
BACKGROUND: Current National Health Service policy in England encourages enhanced digital access in primary care service provision. In this study, we investigate 'digital facilitation' - that range of processes, procedures and personnel which seeks to support National Health Service primary care patients in their uptake and use of online services. OBJECTIVES: Identify, characterise and explore the potential benefits and challenges associated with different models of digital facilitation currently in use in general practice which are aimed at improving patient access to online services in general practice in England. Use the resulting intelligence to design a framework for future evaluations of the effectiveness and cost effectiveness of such interventions. Explore how patients with mental health conditions experience digital facilitation and gauge their need for this support. DESIGN: Observational mixed-methods study (literature review, surveys, ethnographic observation and interviews); formal synthesis of findings. SETTING: General practice in four regions of England. PARTICIPANTS: Practice survey: 156 staff. Patient survey: 3051 patients. Mental health survey: 756 patients. General practitioner patient survey: 3 million responders. Ethnographic case-studies: 8 practices; interviews with 36 staff, 33 patients and 10 patients with a mental health condition. Stakeholder interviews: 19 participants. INTERVENTION: Digital facilitation as undertaken in general practice. MAIN OUTCOME MEASURES: Patient and practice staff reported use of, and views of, digital facilitation. DATA SOURCES: Surveys, qualitative research; national General Practitioner Patient Survey (2019-22). REVIEW METHODS: Scoping-review methodology applied to academic and grey literature published 2015-20. RESULTS: While we did find examples of digital facilitation in routine practice, these often involved using passive or reactive modes of support. The context of COVID, and the necessary acceleration (at that time) of the move to a digital-first model of primary care, shaped the way digital facilitation was delivered. There was lack of clarity over where the responsibility for facilitation efforts lay; it was viewed as the responsibility of 'others'. Patients living with mental health conditions had similar needs and experiences regarding digital facilitation to other patients. LIMITATIONS: The context of the COVID pandemic placed limitations on the project. Fewer practices responded to the practice survey than anticipated; reconfiguration of general practices to support COVID measures was a key consideration during non-participant observation with social distancing and other measures still in place during fieldwork. CONCLUSIONS: Digital facilitation, while not a widely recognised concept, is important in supporting the move to a National Health Service with enhanced digital opportunities and enhanced digital access. General practice staff are allocating resources to provide such efforts in general practices in England. The establishment of clear lines of responsibility, the development of digital tools and platforms that work for patients and practice staff, and investment in staff time and training are needed if digital facilitation is to support the intended digital revolution. FUTURE WORK: We did not find one single dominant or preferred model of digital facilitation which might reasonably be considered to form the basis of an intervention to be tested. Rather, there is a need to co-develop such an intervention with patients, general practice staff and relevant policy experts. We outline a framework for a future evaluation of such an intervention. STUDY REGISTRATION: This study is registered as ResearchRegistry6523 (www.researchregistry.com/browse-the-registry#home/?view_2_search=Di-Facto&view_2_page=1) and PROSPERO CRD42020189019 (www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019). FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128268) and is published in full in ; Vol. 12, No. 32. See the NIHR Funding and Awards website for further award information.
背景：目前，英国国民保健制度鼓励在初级保健服务中增强数字接入。在这项研究中，我们调查了“数字促进”——一系列旨在支持英国国民保健制度初级保健患者接受和使用在线服务的流程、程序和人员。
目的：确定、描述和探讨当前在普通实践中使用的不同模式的数字促进，这些模式旨在改善英格兰普通实践中在线服务的患者获取，并探索这些干预措施的潜在效益和成本效益的评估框架。调查心理健康状况患者的数字促进体验，并评估他们对此类支持的需求。
设计：观察性混合方法研究（文献综述、调查、民族志观察和访谈）；对研究结果进行正式综合。
设置：英格兰四个地区的普通实践。
参与者：实践调查：156 名员工；患者调查：3051 名患者；心理健康调查：756 名患者；普通医生患者调查：300 万回应者；民族志案例研究：8 个实践；与 36 名员工、33 名患者和 10 名患有心理健康状况的患者进行访谈；利益相关者访谈：19 名参与者。
干预措施：普通实践中的数字促进。
主要观察指标：患者和实践员工报告数字促进的使用情况和看法。
数据来源：调查、定性研究；全国普通医生患者调查（2019-2022 年）。
审查方法：应用于 2015-20 年发表的学术和灰色文献的范围综述方法。
结果：尽管我们在常规实践中确实发现了数字促进的例子，但这些例子通常涉及使用被动或反应性的支持模式。COVID 的背景以及将初级保健转移到数字优先模式的必要性，塑造了数字促进的实施方式。促进工作的责任归属并不明确；它被视为“他人”的责任。患有心理健康状况的患者在数字促进方面的需求和体验与其他患者相似。
局限性：COVID 大流行的背景对项目设置了限制。参与实践调查的实践比预期的要少；为支持 COVID 措施而对普通实践进行的重新配置是在非参与观察期间的一个关键考虑因素，社会距离和其他措施仍在进行中。
结论：数字促进虽然不是一个广泛认可的概念，但在支持英国国民保健制度提供增强的数字机会和增强的数字接入方面很重要。英格兰的普通医生员工正在向普通实践分配资源以提供此类服务。如果数字促进要支持预期的数字革命，就需要明确责任、开发适合患者和普通医生员工的数字工具和平台，并投资于员工时间和培训。
未来工作：我们没有找到一个单一的主导或首选的数字促进模式，可以合理地被认为是作为测试的干预措施的基础。相反，需要与患者、普通医生员工和相关政策专家共同开发此类干预措施。我们概述了这种干预措施的未来评估框架。
研究注册：本研究在 ResearchRegistry6523（www.researchregistry.com/browse-the-registry#home/?view_2_search=Di-Facto&view_2_page=1）和 PROSPERO CRD42020189019（www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019）上注册。
资金：该奖项由英国国家卫生和保健研究所（NIHR）健康和社会保健提供，在；第 12 卷，第 32 期。有关该奖项的进一步信息，请参见 NIHR 资助和奖项网站。
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