Electronic implementation of patient-reported outcome measures in primary health care - a mixed method systematic review. (Preprint)

Abstract

BACKGROUND Managing chronic diseases remains a significant challenge in OECD countries. Digital tools, especially electronic PROMs (ePROMs), have shown potential in improving data collection and healthcare delivery but their implementation in primary health care is still scarce. OBJECTIVE We aimed to describe the implementation and effectiveness of ePROMs in chronic disease management in primary health care settings and to identify associated barriers and facilitators. METHODS We conducted a mixed-method systematic review following Cochrane Methods and PRISMA guidelines, including studies that implemented ePROMs among adults to manage chronic diseases. We extracted outcomes related to patient health, provider workflow, costs, and implementation factors. We used the RE-AIM Framework to assess the reach, efficacy, adoption, implementation, and maintenance of ePROMs. RESULTS Our search yielded 12,168 references, from which 22 studies were included after screening and exclusions. These studies, conducted mainly in the United States and Canada, covered various chronic diseases and utilized diverse ePROMs tools, primarily mobile applications. While some studies reported improvements in patient health outcomes and self-management, others indicated no significant change. Barriers included digital literacy and integration into existing workflows, whereas facilitators involved personalized approaches and existing patient-provider relationships. CONCLUSIONS Success in implementing ePROMs in primary health care appears to hinge on addressing digital literacy, ensuring personalization and meaningful patient-provider interactions, carefully integrating technology into clinical workflows, and conducting thorough research on their long-term impacts and cost effectiveness. Future efforts should focus on these areas to fully realize the benefits of digital health technologies for patients, providers, and healthcare systems. CLINICALTRIAL PROSPERO Systematic Review Registry (ID: CRD42022333513). INTERNATIONAL REGISTERED REPORT RR2-10.2196/48155