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. / Thesis / Master of Science (MSc) / Patient outcomes such as experience and timeliness of care are frequently viewed as aims
of quality health care. Although past studies indicate digital health supports quality care,
the real-world effectiveness of digital health is underexplored in Ontario. This thesis
aimed to explore relationships between real-world use of digital health in Ontario and
primary care experience and access using survey data. This study found very few survey
respondents used digital health before the COVID-19 pandemic. The primary care
experience and access to care of adults who did use digital health did not differ very much
from adults who did not use the technology. Some outcomes differed in adults who
booked their primary care appointment online compared to those who did not; however,
the study could not conclude on the relationship. Other personal factors such as age and
residence area impacted the quality of primary care. This study was limited due to the
lack of digital health users. Future studies should explore digital health's impact on
patient outcomes beyond the pandemic.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/27740 |
| Date | January 2022 |
| Creators | Pasat, Zain |
| Contributors | Costa, Andrew, eHealth |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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