Evaluating the digital front door to primary care: drivers of adoption and impact on healthcare equity and efficiency
Author(s)
de Oliveira Salgado Rodrigues, Daniela Sofia
Type
Thesis
Abstract
Health systems worldwide face excessive delays for primary care access. The digital front door to primary care is a promising policy intervention that has been introduced in England to tackle this problem. Having an online access route to primary care means that patients can use an online platform to submit a written request to the practice. This route complements traditional access routes, i.e., calling and visiting the practice in person. It is expected to assist patients contacting practices when in need, ultimately increasing primary care utilisation and reducing unplanned hospital care. However, there are equity concerns about potential negative repercussions on certain patient groups. Using advanced statistical methods, this thesis evaluates the online access route to primary care by examining the factors driving its adoption and estimating its causal impact on healthcare equity and efficiency. Results showed wide variation in online access adoption. The main actionable drivers of adoption were the socioeconomic status of the registered patient population, practice-led online messaging activity which is likely to reflect workforce's digital capability and practice's digital infrastructure, support from receptionists and internet connectivity at the practice and patients' residential area. The online access route led to an increase in primary care provision and in some cases, to a small reduction in unplanned hospital care. Most importantly, there was no evidence of increased age and socioeconomic-related inequity in healthcare utilisation across care settings. These findings support the introduction of the online access route in primary care, but also highlight how important it is to maintain traditional access routes and have an agreed criteria for resource allocation that is based on clinical need, equally applied across access routes. To promote a wider adoption of the online access route, future initiatives could consider patients' deprivation levels, workforce's digital capability and practice's digital infrastructure.
Version
Open Access
Date Issued
2023-08-03
Date Awarded
01/11/2023
License URL
Advisor
Mayer, Erik
Darzi, Ara
Barahona, Mauricio
Kreif, Noemi
Sponsor
Imperial College London
National Institute for Health Research (Great Britain)
Grant Number
PSTRC-2016-004
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)