Keynote

Dr. Ana Luisa Neves

Associate Director / Advanced Research Fellow at the NIHR Patient Safety Translational Research (PSTRC), Imperial College London. Associate Professor at the Center for Health Technology and Services Research / Department of Community Medicine, Health Information and Decision, University of Porto.

Dr Ana Luisa Neves is Deputy Director of MSc Patient Safety and Module Lead (Digital Health) at the Masters Public Health, at Imperial College London, as well as Module Lead at the PhD Programme in Health Data Science at University of Porto. Dr Ana Luisa Neves also oversees the academic support to the WHO Global Patient Safety Collaborative, a multi-national consortium designed to strengthen patient safety leadership, capacity building and research development in low and middle-income countries.

Digital technologies: opportunities and challenges for better, safer and more equitable primary care

Digital technologies may improve quality of primary care by improving patient empowerment, access to personal health information, and increased involvement in the self-management of their health and disease. However, with the widespread use of these digital solutions, there is a growing need to evaluate their impact, in order to better understand their risks and benefits, and to inform health policies that are both patient-centred and evidence-based. It is therefore critical to evaluate their impact, and map it against the six domains of healthcare quality: patient-centredness, effectiveness, efficiency, safety, timeliness and equity.

Using digital platforms, such as patient portals and mobile apps as tools to provide patients with access to their health information can positively impact health outcomes (i.e. glycemia levels) and improve patient safety outcomes, such as general adherence and medication safety. However, more studies are necessary to enhance meta analytical power and assess the impact in other domains of care.

For decades, digital technologies have promised to help address many challenges in primary care. Around the world, countless initiatives have made considerable efforts to implement remote care approaches into their existing healthcare systems. However, despite the promise, a wide range of barriers have limited widespread adoption, including cultural, regulatory and policy, social security, industrial and technical, knowledge, financial, and market-related barriers.

With the onset of COVID-19, we experienced another radical transformation in primary care - the shift to remote care. Over the course of a few weeks, primary care physicians and patients worldwide have swiftly transitioned from face-to-face consultations to remote solutions. Remote care has reduced risks of viral transmission by deflecting patient flow from healthcare physical facilities, whilst simultaneously allowing physicians to continue providing care to vulnerable patients who require shielding. It has supported the triage of patients with COVID-19 related symptoms (potentially optimising the use of limited healthcare resources), supported monitoring of COVID-19 patients, and strengthened epidemiological surveillance efforts. In addition to COVID-19-related care, digital tools have also contributed extensively to the provision of care for both chronic diseases and, in some circumstances, acute care. However, some concerns have also been raised, particularly concerning potential safety issues regarding the monitoring COVID-19 patients, and worsening health inequalities for patients who are not technologically literate or have hearing impairment.

As primary care embraces technology (ie, with virtual care and telemedicine), there are important concerns about the impact of digital approaches widening the digital divide, i.e. entrenching healthcare disparities for low-income, racial–ethnic minority and linguistically diverse populations. It is therefore critical that future research widely evaluates patient interest, access and skills to using digital care tools, leading to the development of tailored interventions to match patient preferences and needs. In this context, mixed-methods approaches and implementation science studies can be an important tool to understand use, usability, and uptake, as well as impact on health outcomes.