Examining the relationship between the “real world” adoption of digital health tools and primary care experience

Abstract

Background: Patient experience is a crucial measure of patient-centeredness and quality care delivery. Digital health may contribute to patient experience by offering tailored and accessible avenues of care. Purpose: I explored how access to digital health, including telehealth, electronic health records, and online booking, may be associated with improved primary care experience for Ontario adults. Methods: This cross-sectional study included Ontario adults (16 years or older) who responded to waves 27 to 29 of the Health Care Experience Survey (HCES) between May 2019 and February 2020. Adults who did not see their primary care provider within the past 12 months or did not have a primary care provider were excluded. Outcomes included a summed patient experience score derived from five HCES experience-related questions and time to appointment for a health concern. Associations between outcomes and digital health interventions were tested through chi-square tests and logistic regression while adjusting for confounders and stratifying by health care utilization. Results: 3,700 participants met the inclusion criteria, where 2204 remotely communicated with their primary care provider (59.6%), 98 digitally accessed health records (2.6%), and 120 booked an appointment online (3.2%). We observed no significant associations between digital health tools and patient experience or time to appointments through chi-square tests. Participants with over three primary care visits in the past year who accessed online booking were 84% less likely to report poorer experience scores than participants without online booking access [Adjusted OR 0.16, 95% CI 0.02 – 0.56, p < 0.05]. Participants with three or fewer primary care encounters who accessed online booking, compared to the same reference group, were 72% less likely to report having a same or next day appointment with their primary care provider [Adjusted OR 0.25, 95% CI 0.08 – 0.64, p < 0.01]. Significant associations were observed between other sociodemographic factors and patient experience and access to care outcomes. Interpretation: The associations between digital health access and patient experience and access to care were inconsistent across different analyses. Despite experimental studies observing the benefits of digital health adoption in primary care, the effect is unclear in the real-world context. Furthermore, drawing conclusions on the relationship between digital health and quality care outcomes was limited due to the lack of adoption of digital health before the COVID-19 pandemic. As digital health adoption grows, future research should utilize the availability of further data to evaluate the effectiveness of digital health in Ontario primary care.