Objectives: This study aimed to evaluate patterns of uptake and adoption of the NHS App. Data metrics from the NHS App were used to assess acceptability by looking at total app downloads, registrations, appointment bookings, GP health records viewed, and prescriptions ordered. The impact of the UK COVID-19 lockdown and introduction of the COVID Pass were also explored to assess App usage and uptake. Methods: Descriptive statistics and an interrupted time series analysis were used to look at monthly NHS App metrics at a GP practice level from January 2019-May 2021 in the population of England. Interrupted time series models were used to identify changes in level and trend among App usage and the different functionalities before and after the first COVID-19 lockdown. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were used for reporting and analysis. Results: Between January 2019 and May 2021, there were a total of 8,524,882 NHS App downloads and 4,449,869 registrations. There was a 4-fold increase in app downloads from April 2021 (650,558 downloads) to May 2021 (2,668,535 downloads) when the COVID Pass feature was introduced. Areas with the highest number of App registrations proportional to the GP patient population occurred in Hampshire, Southampton and Isle of Wight CCG, and the lowest in Blackburn with Darwen CCG. After the announcement of the first lockdown (March 2020), a positive and significant trend in the number of login sessions was observed at 602,124 (p=0.004)** logins a month. National NHS App appointment bookings ranged from 298 to 42,664 bookings per month during the study period. The number of GP health records viewed increased by an average of 371,656 (p=0.001)** views per month and the number of prescriptions ordered increased by an average of 19934 (p<0.001)*** prescriptions per month following the first lockdown. Conclusion: This analysis has shown that uptake and adoption of the NHS App was positive post lockdown, and increased significantly due to the COVID Pass feature being introduced, but further research is needed to measure the extent to which it improves patient experience and influences health service access and care outcomes.

ImportanceDown syndrome is the leading genetic cause of intellectual disability and automatically qualifies individuals for Social Security Insurance. Therefore, Medicaid is the major health insurance provider for a population at high risk for dementia, obesity, and premature mortality. Despite the importance of Medicaid for adults with Down syndrome, little is known about how this population uses Medicaid.ObjectiveTo describe enrollment in, health care use in, and cost to Medicaid for adults with Down syndrome compared with adults with intellectual disability and a random sample of adults enrolled in Medicaid.Design, Setting, and ParticipantsIn this cohort study, the data are from a claims cohort of adults aged 18 years or older enrolled in Medicaid at any point between January 1, 2011, and December 31, 2019. Participants were enrollees with 1 or more inpatient claim or 2 or more other claims with an International Classification of Diseases, Ninth Revision code or an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for Down syndrome or intellectual disability as well as a random sample of those without developmental disability. Analyses were conducted from June 2022 to February 2023.Main Outcomes and MeasuresData were linked across 2 data reporting systems. Main outcomes were enrollee demographic characteristics, enrollment characteristics, cost, and service use.ResultsThis cohort study included 123 024 individuals with Down syndrome (820 273 person-years of coverage; mean [SD] age, 35 [14.7] years; median age, 33 years [IQR, 21-48 years]; 51.6% men; 14.1% Black individuals; 16.7% Hispanic individuals; and 74.6% White individuals), 1 182 246 individuals with intellectual disability (mean [SD] age, 37.1 [16.8] years; median age, 33 years [IQR, 22-50 years]; 56.5% men; 22.0% Black individuals; 11.7% Hispanic individuals; and 69.5% White individuals), and 3 176 371 individuals with no developmental disabilities (mean [SD] age, 38 [18.6] years; median age, 33 years [IQR, 21-52 years]; 43.8% men; 23.7% Black individuals; 20.7% Hispanic individuals; and 61.3% White individuals). Median enrollment in Medicaid for a person with Down syndrome was 8.0 years (IQR, 5.0-9.0 years; mean [SD], 6.6 [2.6] years). Costs were higher for the Down syndrome group (median, $26 278 per person-year [IQR, $11 145-$55 928 per person-year]) relative to the group with no developmental disabilities (median, $6173 per person-year [IQR, $868-$58 390 per person-year]). Asian, Black, Hispanic, Native American, and Pacific Islander adults with Down syndrome had fewer costs and claims per person-year compared with White adults with Down syndrome.Conclusion and RelevanceThis cohort study of individuals with Down syndrome enrolled in Medicaid found consistent enrollment and high use of health care in a population with high health care needs. Results were similar comparing individuals with Down syndrome and those with intellectual disability, with both groups differing from a sample of Medicaid enrollees with no developmental disabilities. Medicaid data are a useful tool for understanding the health and well-being of individuals with Down syndrome.

Objectives: We evaluated patterns of uptake of the NHS App using data metrics on total app downloads, registrations, appointment bookings, GP health records viewed, prescriptions ordered. Sub-group differences in App registration and the impact of COVID-19 were also explored. Methods: Descriptive statistics and time series analysis explored monthly NHS App use from January 2019-May 2021. Interrupted time series models were used to identify changes in level and trend in use of different functionalities before and after the first COVID-19 lockdown. Negative binomial regression assessed differences in App registration by markers of GP level socio-demographic variables. Results: Between January 2019 and May 2021, there were 8,524,882 NHS App downloads and 4,449,869 registrations. There was a 4-fold increase in App downloads when the COVID Pass feature was introduced. Analyses by socio-demographic data found 25% lower registrations in the most deprived practices (p<0.001), and 44% more registrations in the largest sized practices (p<0.001). Registration rates were 36% higher in practices with the highest proportion of registered white patients (p<0.001), 23% higher in practices with the largest proportion of 15–34-year-olds (p<0.001) and 2% lower in practices with highest proportion of people with long-term care needs (p<0.001). Conclusion: The uptake of the NHS App substantially increased post lockdown, most significantly after the COVID Pass feature was introduced. We identified an unequal pattern of App registration and the use of different functions also varied. Further research is needed to measure the extent of the divide and its impact on patient experience and care outcomes.

BackgroundThe NHS App was launched as a ‘front door’ to digitally enabled health services, offering a range of services including appointment booking and ordering prescriptions. The extent of App use and its impacts on digital inclusion is under-explored.AimTo evaluate patterns of App uptake and adoption among different population groups.MethodInterrupted time series analyses explored aggregate monthly App usage from January 2019 - May 2021. Regression model assessed differences in App registration by markers of GP level socio-demographic variables. Qualitative interviews and focus groups involving 83 participants were conducted and analysed thematically.ResultsThere were 8,524,882 App downloads and 4,449,869 registrations. Negative binomial models found 25% less registrations in the most deprived practices (P<0.001) and 44% more registrations in the largest practices (P<0.001). Registration was 36% more in practices with the highest percentage of White patients (P<0.001) and 23% more in practices with highest percentage of 15–34-year-olds (P<0.001). In contrast, App registration was 13% less in practices with highest percentage of males (P<0.001) and 2% less in those with highest percentage of people with long-term care needs (P<0.001). Qualitative evaluation found that the App was not perceived as relevant or accessible for all and there are important cultural considerations (for example, language barriers and some restrictions in symptom checking for non-White skin). However, it can enable patients to hold services accountable.ConclusionThere is high uptake of the NHS App but there are differences in adoption rates among different population groups and issues of relevance and accessibility, that warrant further work.