Impact of the digital healthcare transition

Research question (problem statement) General practice care in the Netherlands is under increasing pressure due to an ageing population, a growing demand for care, and the transfer of additional tasks from other healthcare domains to primary care. To keep general practice care of high quality, accessible, and affordable, changes are needed. The use of digital healthcare is often seen as one of these necessary changes, as it is expected to improve efficiency in care processes and strengthen patients’ ability to manage their own health. But to what extent is this promise being realized, and what are the experiences with digital care in general practice? This thesis therefore addresses the following research questions: “How do general practitioners (GPs) experience the digital healthcare transition, what is the relationship between digital healthcare use and workload in general practice, which factors influence successful and sustained adoption of digital healthcare, and how does this vary between practices over time?” Research methods To answer this question, several research methods were used and various digital healthcare applications were investigated: 1. Systematic literature review: all relevant publications on the impact of digital healthcare use on workload in general practice published between 2010 and 2020 were identified and analyzed. 2. Observational, retrospective study: based on data from general practice information systems, factors associated with citizens’ consent for the electronic exchange of medical data by GPs between 2017 and 2019 were examined. 3. Surveys and interviews: to explore the experiences of GPs with digital health applications during the COVID-19 pandemic and to elucidate differences in use between different types of practices, general practitioners were surveyed. 4. National monitoring data on digital health use: to study the adoption of video consultations in general practice during the pandemic monitoring data was analyzed. Main findings This thesis shows that the use of digital healthcare applications: 1. Often increases GP workload, particularly during the early phase of adoption and when digital tools do not fit well with existing work processes. 2. At the beginning of the COVID-19 pandemic, increased sharply and temporarily in almost all general practices, to a similar degree. 3. During the pandemic was dependent on a good integration into daily practice, user-friendly applications, digital skills, and adequate technical and financial support during implementation. 4. May improve patient self-management and the doctor-patient relationship, and is generally not experienced as negative by GPs, despite increases in workload associated with its use. 5. Can be limited if citizens do not provide consent, as with the electronic exchange of medical data; consent decisions differ between citizens with generally higher versus lower healthcare use. Conclusion and key recommendations Digital healthcare has the potential to contribute to better and more accessible general practice care, but only under specific conditions. Good integration into existing workflows, user-friendly digital healthcare applications, and support for healthcare professionals and patients with limited digital skills are essential. In addition, it is important to (a) better understand why digital healthcare often fails to reduce workload and (b) increase equal access to general practice care.