Can digital innovation transform rural primary health care? A systematic review protocol

Introduction

There is a growing consensus among the global health community that the strategic and innovative use of digital technology is essential to strengthen and improve equitable provision of and access to healthcare. In 2020, recognising this need to strengthen digital innovation, the WHO developed a global strategy on digital health.1 Their strategy aims to revolutionise a vision of improving health by enabling the development and adoption of appropriate, acceptable, affordable and sustainable digital health solutions for improved health and well-being. Digital health technology has the potential to revolutionise the delivery of health services, particularly through more efficient interventions and prevention options manageable within primary healthcare settings.2 3 Enabling tracking and monitoring of patient health, timely intervention to prevent disease progression, and real-time disease treatment and management through digital solutions provide unique opportunities for improved health outcomes.4 5

The Australian Institute of Health and Welfare defines digital health as an umbrella term, referring to a broad range of technologies used in healthcare with the primary objective of treating patients, while also accumulating or disseminating health information.4 This technology can include mobile health applications, telehealth, telemedicine, wearable devices, robotics and artificial intelligence. The digital transformation of healthcare can include the use of technologies such as the Internet of Things, virtual care, remote monitoring, artificial intelligence and machine learning, big data analytics and smart wearable devices. It also relates to platforms that enable remote data capture and the exchange of data as well as the dissemination of relevant information across the health ecosystem. These data-driven technologies can create a continuum of care and standardisation with the potential to enhance health outcomes by improving medical diagnosis, personalised treatment decision-making, self-management of care and person-centred care, and digital therapeutics and imaging.

Although the use of innovative digital technologies to increase access and enhance the quality of primary healthcare is increasing, the extent to which these technologies are being adopted and utilised by rural populations is not yet known. Over 46% of the global population resides in rural areas, predominantly in less-developed countries.6 Rural populations often have worse health outcomes and experience unique challenges and barriers accessing appropriate health services.7 Although these disparities are attributable to a wide range of factors including health workforce shortages and socioeconomic disadvantages, reduced access to health services is arguably a key factor that creates significant barriers.8 9 The last 10 years has seen urban primary healthcare services increasingly using innovative digital technology to bridge healthcare access gaps, streamline efficient service delivery and optimise patient outcomes. In contrast, there is currently a paucity of evidence from rural settings that demonstrates the impact of digital technology on health systems and health outcomes. Although strategies to optimise the digital health system have been developed in several countries, including Australia,10 11 evidence demonstrating the specific implementation of these strategies to rural regions remains limited. In a rural setting, timely access to relevant data for clinical decision-making is equally crucial as for urban settings. By overcoming the tyranny of distance, a digitally innovative approach can significantly improve access for rural populations, and thus has the potential to improve health outcomes, reduce costs through avoidable hospitalisations and reduced travel, enhance patients’ quality of life with continuity of care as well as address healthcare system workflow inefficiencies.12

The next frontier of primary healthcare innovation relies on the broader use of digital technologies, with a focus on prevention, personalisation and long-term outcomes.13 14 Improving health outcomes by providing digital healthcare access regardless of a person’s location can ensure equitable access to appropriate primary healthcare services using digitally empowered health transformations. Despite the potential for innovative disruption, there may be unforeseen risks to future healthcare systems. However, increased continuity of care provided through digital health can improve effectiveness, efficiency and delivery of healthcare in rural locations, possibly outweighing any potential risks. Understanding existing evidence and identifying knowledge gaps to further promote and progress digital innovation within rural primary healthcare is therefore necessary. This systematic review aims to synthesise evidence regarding the use and integration of digital health technology within primary healthcare services for rural populations across the world.