Keywords: acceptability; digital literacy; digital tools; hybrid care; patient portal; quality of life; teleconsultation

Background:

Continuity of care in Europe faces increasing pressure from population aging, chronic disease, and rising primary care demand. Digital tools such as patient portals and phone consultations are central to hybrid care models extending coordination beyond in-person visits. Understanding patient perceptions is key to ensuring digital transformation strengthens, rather than fragments, continuity of care.

Research questions:

This study aimed to evaluate the acceptability of patient portals and phone consultations in Slovenian primary care and identify socio-demographic, clinical, and digital factors associated with acceptability.

Method:

Between April and June 2025, a multicentre cross-sectional survey was conducted in four primary healthcare centres in Slovenia. The sample included 214 individuals who had used both patient portals and phone consultations in the previous 12 months. Data covered socio-demographic and clinical characteristics, digital communication skills, quality of life, and annual digital tool use. Acceptability was assessed using the Theoretical Framework of Acceptability (TFA) tool, and univariate and multivariable linear regression analyses identified factors associated with acceptability.

Results:

Among 214 participants (mean age 42.9 ± 14.1 years; 61.2% female), both patient portals and phone consultations were generally acceptable, with similar overall TFA scores (3.9/5). Patient portals were seen as significantly less time-consuming and better for communication, while phone consultations were preferred for accessibility and reliability. Multivariable analyses showed that higher digital communication skills and better quality of life predicted greater acceptability for both, whereas lower education level and more frequent use were associated with higher acceptability of phone consultations.

Conclusions:

Continuity of care requires flexible hybrid models rather than uniform digital solutions. Phone consultations are crucial for access and relational continuity for patients with limited digital skills, while patient portals enhance continuity for digitally confident patients. Investing in digital literacy, supporting general practitioners, and developing interoperable eHealth systems is essential to ensure digital tools strengthen coordinated, equitable continuity of care.

Points for discussion:

How can health systems effectively improve digital communication skills among patients, particularly older adults or those with lower education levels, to reduce disparities in access?

What are the best strategies to integrate digital tools into existing primary care workflows without disrupting relational continuity with general practitioners?

How might patient perceptions and acceptability of digital tools differ across countries, and what lessons can Slovenia provide for broader European primary care settings?