Factors influencing Primary Care Physicians recommending patients to use digital health technologies for self-management: A cross-sectional study across 20 countries (Preprint)

Abstract

Expanding access to self-management via Digital Health Technologies may supplement traditional care, mitigating pressures on primary care through self-management. Primary Care Physicians can play a critical role in the integration of digital health technologies into patient care, but it is unclear what factors influence Primary Care Physicians’ recommendation of such technologies.

To identify the factors associated with Primary Care Physicians recommending digital health technologies to patients for self-management before, and during the pandemic.

Primary Care Physicians across 20 countries completed an online questionnaire between June-September 2020. The outcome was self-report of recommending patients to at least one of six listed forms of digital health technologies (symptom checker/self-assessment tools, online information resources, health trackers, and mindfulness apps, online counselling and crisis resolution services). Multivariate logistic regression models were performed to identify factors associated with recommending digital health technologies to patients before and during the pandemic. McNemar's Chi-squared (χ2) test was used to analyse changes during the pandemic.

A total of 1,592 Primary Care Physicians were included. Before the pandemic, odds of recommending digital health technologies for self-management were lower for Primary Care Physicians not involved in teaching (aOR 0.64, 95%CI 0.51-0.8), or practising in Turkey, Australia, Chile, Colombia, France, Italy, Poland, Portugal, Slovenia, and Spain (aORs range: aOR 0.18, 95%CI 0.1-0.34 [Turkey]; aOR 0.58, 95% CI 0.36-0.93) [Australia]). During the pandemic, Primary Care Physicians practising in rural settings had higher odds of starting to recommend digital health technologies (aOR=2.07 [1.19-3.58], as well as those from Brazil, Colombia, and Italy (aOR= 3.18 [1.13-8.76]; 6.89 [2.97-16.6] and 3.85 [1.85-8.21], respectively]. There was no significant difference in recommending digital health technologies before and during the pandemic (53.2% vs 54.7%, P=0.215).

Involvement in teaching (pre-pandemic) and practising in a rural setting (during the pandemic) positively influenced recommendation of digital health technologies. Significant variation in recommending digital health technologies was present across countries. Further research is indicated to better understand potential drivers of variation, including characteristics of the populations served, as well as national health systems and policies.