5.1. Context of the COVID-19 Pandemic
PHC practice has been impacted by the ongoing COVID-19 pandemic in many dimensions. Digital technologies, on the other hand, have evolved and adapted as a result. Telemonitoring, apps, wearable devices, and artificial intelligence are all examples of this.
Previously, digital technology acceptance and implementation in PHC had been difficult and delayed (60–62), but COVID-19 appeared to open new doors and accelerate adoption rates. Primary care providers (PHCPs) or general practitioners (GPs) depended heavily on digital DHTs to continue providing care during the COVID-19 epidemic. We found that DHTs allowed them to provide a wide variety of services, from diagnosis to treatment and palliative care, as well as preventative and vaccine drives. In addition, DHTs were utilized by GPs to increase the number of non-COVID-19 consultations and referrals to secondary care (63) that would have been otherwise dismissed due to COIVDI-19's early responses, such as cancelling non-urgent treatment, lockdowns, and so on.
Due to huge demand for other COVID-19 commitments, primary care centres and offices were frequently understaffed. As a result, different and inventive solutions were required in order to ensure that patients received sufficient care. Thus, DHT use in primary (and secondary) care has risen at previously unheard-of rates since then (64, 65). In the early days of the pandemic, an increase in the usage of remote consultations in PHC was extensively noted. In April 2020, for example, 64–80% of PHCPs in the United Kingdom and the Netherlands used video consultations, 13% used telemonitoring, and 73% used electronic asynchronous consultations (66). The usage of DHTs in hospitals appeared to be growing much more. The utilization of video consultations has increased by 8729% at one academic hospital in New York (67).
Remote monitoring apps for suspected or confirmed COVID-19 patients have equally evolved in hospitals, in addition to video consultations. The COVID-19 box is an example of a home monitoring system that allows patients to check their vital signs three times a day and have daily video chats with the hospital (65). In family medicine, the remote follow-up of patients at high risk of worsening with moderate or severe COVID-19 has brought added value. In this case, unnecessary visits to the emergency room were avoided, and recovery at home was facilitated instead. In remote patient management programs, systems incorporating the collaboration of primary and secondary health care professionals (TeleConnect, for example) have evolved (68). This has a lot of potential since it not only connects patients and physicians, but also physicians among themselves. These technologies either connect PCPs between themselves or with specialists, a habit that was being done in person before the COVID-19 pandemic. These vital connections are critical to patient care, facilitating care coordination and improving the patient's managed care. Furthermore, it could allow patients to stay at home longer while still receiving all the care they require.
Digital sensors were among the DHTs that were used for a variety of applications (38), including chronic condition management, diagnosis, and testing, among others. Many examples exist that show how sensors developed during the COVID-19 era have the ability to revolutionize how current and future PHC care is delivered. For example, a sensor created at Johns Hopkins University (69) can, for example, revolutionize virus diagnostics (i.e., virus testing). During early testing, the sensor detected SARS-CoV-2 in saliva samples with 92% accuracy, which was comparable to PCR assays. The sensor was also extremely effective at detecting the presence of other viruses, such as H1N1 and Zika. Researchers have also demonstrated that this sensor, which requires no sample preparation and little operator skill, has a strong advantage over conventional testing methods, particularly for population-wide testing. It has been shown to overcome the limitations of the two most common forms of COVID-19 tests, namely the PCR and rapid tests. Its key novelty is that it is a label-free technology, which means it does not require any additional chemical modifications such as molecular labelling or antibody functionalization. The latter implies that this sensor could be used in wearable devices in the future.
Digital health literacy is another key aspect of DHT use that has been observed in the COVID-19 pandemic. Digital health literacy played an important role during the COVID-19 pandemic in Pakistan, helping to improve maternal, child, and family health in primary healthcare settings in disadvantaged areas (40). It has also helped to improve patient safety and referral to other health and social issues. Community healthcare workers were also valuable in this process by using smartphone and internet-based digital health literacy initiatives to empower disadvantaged women. Research has shown that literacy and awareness-raising interventions in primary health care settings are more beneficial to underserved women in other areas of maternal and child health, such as nutrition and food security, chronic disease management and multimorbidity, and mental health counselling (40). Moreover, literacy in digital health interventions for patients can, for example, provide skills in short message systems (SMS) for cardiac patients, provide skills in mobile services for patients with diabetes, provide skills in Mobile devices that allow patients to access online consultations from a physician. Other skills that could be improved include interventions that empower patients to provide better information needed by healthcare providers and for better record-keeping and management of patient information.
Briefly, digital health literacy shares exactly two wider visions with regular health literacy, both from a clinical and public health perspectives, across the three domains of health: health care, disease prevention, and health promotion. These are individual skills regarding health information. That is, information that enhances preferred actions in the care relationship between a "patient" and their "caregivers". This therefore defines a clinical vision. Furthermore, this encompasses a broader set of cognitive, social, and civic skills. These skills enable a patient to use information and public services, to gain greater control over his or her own condition(s) (i.e., a patient gains understanding of his or her illness), and, finally, to make decisions to solve community health problems (i.e., a patient participates in collaborative efforts to find solutions to community health issues).The latter defines a public health vision that is considered a key element in decision-making, health promotion, and preventing ill-health. Importantly, patients access, understand, evaluate, and apply skills related to using health information. This illustrates exactly the skills aimed at strengthening the promotion of self-care and self-management of one’s health. All of these are very important because the individuals who have acquired them can use information that could improve their health. S/he would understand, for example, why it is important to use a face mask for COVID-19, to maintain social distance, to take medications as prescribed by a healthcare provider, and so on. This would reduce the gap in information between the patient and her/his care provider (i.e., reduce information asymmetry), which would help to better manage the patient's health. In other words, it will enhance information inclusion from the patient's perspective. Therefore, the patient could, for example, determine, on the basis of the packaging of a pharmaceutical product, how often this product should be taken per day. S/he would also be able to understand what her/his doctor says, and s/he would be able to find information about her/his disease. In this case, the patient would become a good health care partner. To reiterate, improving digital health literacy would not only be a potential solution for successfully embracing digital technologies in healthcare, but it would also allow patients to be aware of and own their health conditions, allowing for better partnerships in delivering health care for both individuals and society as a whole.
Overall, DHTs were widely used during the COVID-19 pandemic, and they showed the potential to improve care (including health-care quality (70–73)). Their promising applications are still being explored. Thus, we need to make sure we don't miss out on the chance provided by COVID-19 to apply DHTs in our daily health care practice.
On the other hand, despite the scope of our study not being focused on the limitations of DHs or why the healthcare sector has been reluctant to accelerate the use of DHT in the past, research claims that healthcare has been slow to adopt digital technologies, while their proliferation has revolutionized many other industries by increasing efficiency and effectiveness (60). Healthcare organizations, particularly physician practices, have been noticeably slow to adopt such technologies. Other researchers have generally looked at potential barriers to DHT use in the past (74–77), especially telehealth (78), but new specific negative concerns have emerged during COVID-19. To mention a few new issues (only the more immediate and illegal aspects): (i) hackers attacking hospitals, clinical analysis centres and medical cyber centres for extorting money, capturing patient data, and preventing clinical activity; (ii) blackmailing people due to clinical data disclosure; and (iii) the threat of introducing the virus into electronic medical devices. We recommend carrying out thorough research of the new negative effects of DHTs that appeared in the COVID-19 era.