University affiliation
Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University.
Main supervisor
Susanna Calling, Associate Professor and Specialist in General Medicine.
PhD project participating in the National Research School in General Medicine.
The demands on primary care are constantly increasing. Decision makers in health care have put forth digitalization as a solution to improve quality and efficiency. However, new digital solutions are often introduced in primary care without sufficient scientific evidence or evaluation. This thesis project aims to be a part of countering the problem. We will scientifically evaluate digitalization in primary care from multiple angles. Specific studies concern staff and patient experience, effects on health care consumption, and digital lifestyle intervention.
Digitalization in health care is a broad term. It includes all types of digital technology from the electronic medical record to artificial intelligence, as well as remote contacts and mobile devices.
Digitalization is increasing in primary care. Expectations have been raised regarding effects on efficiency, quality, and access to care. Concerns include overuse and security issues. More studies to evaluate implementation are needed.
Presently, a new platform for digital symptom assessment and triage is underway in Sweden. Reports on staff experience of similar digitalization have been mixed. Comparably few studies have used an established model for acceptance of new technology.
In Region Scania’s primary care, a service for digital anamnesis and text-based visits was initiated in 2019. Evidence regarding effects of digital visits on health care utilization is conflicting. More research has also been called for to assess which types of complaints are suitable for digital visits.
In a different area of digitalization, lifestyle-promoting text messages have shown positive effects on blood pressure. However, this has not been evaluated in primary care. Therefore, the ongoing randomized controlled trial Primary care USage of Health promoting MEssages (PUSHME) aims to examine the impact of lifestyle-promoting text messages on hypertension and other cardiovascular risk factors in primary care. To optimize the use of digital tools for lifestyle changes, it is vital to understand patient experience and what factors contribute to compliance.
This PhD project aims to provide a broad picture and scientific evaluation of digitalization in the clinical context of primary care in southern Sweden. We will investigate the areas of staff and patient experience, health care utilization, and lifestyle changes.
Paper I explored primary care physicians’ experiences of digitalization in 2019 through qualitative content analysis of free-text comments supplied in a web-based survey, using the Theory of Planned Behavior as a framework.
Paper II is a quantitative survey analysis of primary care nurses’ experience and acceptance of a new platform for digital symptom assessment and triage. The Unified Theory of Acceptance and Use of Technology is used as a framework.
Paper III is a cross-sectional study of the patients that completed a digital visit with Region Scania’s digital primary care service during 2021. Demographics, diagnoses, and follow-up contacts are described and analyzed statistically.
Paper IV is a sub-study to the PUSHME trial. To explore patient experience of the intervention, telephone interviews are conducted with a purposive sample of the participants and analyzed through systematic text condensation.
Paper V is also part of the PUSHME trial. A questionnaire developed according to the Theory of Planned Behavior is used to study the correlation between behavioral predictors and lifestyle changes.
This PhD project will add clinically relevant evidence in several areas of digitalization in primary care. Digital triage and digital visits are relatively new research areas, and studies on staff experience and effects on health care utilization are sparse. If lifestyle advice through SMS is efficient, it can contribute to improved patient health and save resources in a straining primary care.
Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University.
Susanna Calling, Associate Professor and Specialist in General Medicine.