Keywords: Primary health care, telemedicine, health service accessability, continuity of care

Background:

A growing demand for primary health care necessitates more efficient use of resources. Digital platforms for patient–provider communication are often promoted as solutions to improve access and efficiency, but their implications for continuity of care remain insufficiently understood. In Swedish primary health care, patient adoption of such services remains limited, highlighting the need to explore how digital contacts influence patients’ experiences of access, relationships, and ongoing care.

Research questions:

The aim of the study was to explore patients’ experiences with using a digital platform for chat-based consultations to understand their concerns when contacting primary health care services online.

Method:

We conducted 23 semi-structured interviews between March and December 2024 with patients from three health care regions in southeastern Sweden who had used a digital platform to contact their primary health care centre (PHCC). Data were analysed using inductive thematic analysis. In addition, a sentiment analysis was performed, categorising statements as positive, negative, or neutral.

Results:

Patients expected quicker access to their PHCC via the platform, but this was often offset by delays later in the process. Most found the platform easy to navigate, though uncertainty remained about appropriate use cases. Concerns were raised about the automated symptom checker, which was seen as either too broad or too narrow and often failed to interpret or contextualize patient input. Returning patients expressed a desire for more continuity of care and perceived a tension between digital contact and relational continuity. Sentiment analysis revealed that infrequent users of health care responded more negatively than frequent users.

Conclusions:

Digital platforms in primary health care may support access to care but risk weakening relational continuity if patient needs for personalization and ongoing relationships are not addressed. For digital services to contribute to continuity of care they must balance efficiency with relational aspects valued by patients.

Points for discussion:

Digital access versus relational continuity

Continuity for returning and long-term users

Implications for future digital models of care