Sussex Jon, Atherton Helen, Abel Gary, Clark Christopher, Cockcroft Emma, Leach Brandi, Marriott Christine, Newbould Jennifer, Pitchforth Emma, Winder Rachel, Campbell John
RAND Europe, Eastbrook House, Shaftesbury Road, Cambridge, CB2 8BF, United Kingdom, 44 1223353329.
University of Southampton, Southampton, United Kingdom.
JMIR Hum Factors. 2024 Dec 4;11:e52516. doi: 10.2196/52516.
General medical practitioners and other staff at primary care medical practices have an important role in facilitating patient access to online services in the National Health Service in England. These services range from online ordering of repeat prescriptions to conducting online consultations with health care professionals. We have defined "digital facilitation" as that range of processes, procedures, and personnel that seeks to support patients in their uptake and use of online services.
We report how we have synthesized the evidence from a mixed methods study of digital facilitation in primary care in England. The study's objectives were to identify, characterize, and explore the benefits and challenges of different models of digital facilitation in general medical practices in England and to design a framework for evaluation of the effectiveness and costs of digital facilitation interventions.
Our study comprised scoping review of literature, survey of staff in general practices, survey of patients, and ethnography at case study practices plus stakeholder interviews. We compiled a triangulation matrix of the findings from individual work packages through an iterative process whereby each work package's results were first analyzed separately and were then cumulatively combined across work packages in 3 successive workshops. From the resulting matrix, we developed a program theory and an implementation theory and constructed a framework for evaluations of digital facilitation in primary care. The final step of the synthesis process was to discuss the results with national and regional National Health Service stakeholders.
Triangulation yielded a combined set of findings summarized within 11 thematic groupings: 3 setting the scene within which digital facilitation takes place, and 8 related to different types of digital facilitation, their implementation, and effectiveness. Some thematic groupings were evident in the findings of all 4 of the research work packages; others were not addressed in all the work packages but were evident from those where they were addressed. Throughout the synthesis, there were no instances where findings from one work package contradicted the findings of another. Findings either reinforced each other or offered complementary or additional insights. The discussion at the stakeholder meeting held at the end of the study resulted in the research team clarifying some findings but not changing any of them.
Digital facilitation can take many forms, though much of what is currently done in primary care practices in England is reactive and passive. Clear lines of responsibility, digital tools and platforms that work well for patients and practice staff, and investment in staff time and training are all needed if digital facilitation is to deliver on its promise. We propose a framework for future evaluations of the effectiveness and costs of digital facilitation interventions.
在英格兰国民医疗服务体系中，全科医生及基层医疗诊所的其他工作人员在协助患者使用在线服务方面发挥着重要作用。这些服务涵盖从在线重复开具处方到与医护人员进行在线会诊等内容。我们将“数字便利化”定义为一系列旨在支持患者采用和使用在线服务的流程、程序及人员。
我们报告了如何综合来自一项关于英格兰基层医疗数字便利化的混合方法研究的证据。该研究的目的是识别、描述并探索英格兰全科医疗中不同数字便利化模式的益处与挑战，并设计一个评估数字便利化干预措施的有效性和成本的框架。
我们的研究包括文献综述、全科医疗工作人员调查、患者调查、案例研究诊所的人种志研究以及利益相关者访谈。我们通过一个迭代过程编制了一个由各个工作包的研究结果组成的三角验证矩阵，即首先分别分析每个工作包的结果，然后在三个连续的研讨会上将各工作包的结果进行累积合并。从所得矩阵中，我们构建了一个项目理论和一个实施理论，并构建了一个基层医疗数字便利化评估框架。综合过程的最后一步是与国家和地区的国民医疗服务体系利益相关者讨论结果。
三角验证得出了一组综合研究结果，归纳为11个主题分组：3个为数字便利化开展的背景设定，8个与不同类型的数字便利化、其实施及有效性相关。一些主题分组在所有4个研究工作包的结果中都很明显；其他一些主题分组并非在所有工作包中都涉及，但在涉及的工作包中很明显。在整个综合过程中，没有出现一个工作包的结果与另一个工作包的结果相互矛盾的情况。结果要么相互加强，要么提供互补或额外的见解。研究结束时举行的利益相关者会议上的讨论使研究团队澄清了一些结果，但没有改变任何结果。
数字便利化可以有多种形式，不过目前英格兰基层医疗诊所所做的很多工作都是被动反应式的。如果数字便利化要实现其承诺，就需要明确的责任分工、对患者和诊所工作人员有效的数字工具及平台，以及对工作人员时间和培训的投入。我们提出了一个未来评估数字便利化干预措施的有效性和成本的框架。
