Impact of Digital Health on Patient-Provider Relationships in Respiratory Secondary Care: A Systematic Review of Qualitative and Quantitative Evidence

Abstract

Background: Digital health technology adoption has accelerated in respiratory care, particularly since COVID-19, supporting various applications from self-management to telerehabilitation. While these technologies have transformed healthcare delivery, their impact on the patient-provider relationship in specialist respiratory care remains poorly understood.

Objective: To systematically review the literature on the impact of digital health technology on the patient-provider relationship in respiratory secondary care settings and to understand the factors that enhance or diminish this relationship.

Methods: In December 2023, we conducted a systematic review following Cochrane methodology, searching MEDLINE, Embase, CINAHL, Cochrane databases, and PsycINFO. We included qualitative, quantitative, and mixed-methods studies examining digital health interventions in respiratory secondary care. Trained volunteers from the European Respiratory Society CONNECT Clinical Research Collaboration performed screening and data extraction. We conducted a qualitative meta-synthesis of findings, followed by an abductive quantitative data analysis. Three stakeholder workshops were held to interpret findings collaboratively with patients and healthcare professionals.

Results: From 15,779 papers screened, 97 met the inclusion criteria (55 qualitative/mixed-methods studies, 42 quantitative studies). Studies covered various respiratory conditions, including COPD (32%), asthma (26%), and COVID-19 (13%). Four main themes emerged: trust (foundational to the relationship), adoption factors (including clinical context and implementation drivers), confidence in technology (based on functionality and the evidence base), and connection (encompassing communication and a caring presence). Digital health technology can either enhance or diminish trust between patients and clinicians, with patients' perceptions of the motivations behind its implementation being crucial. While technology facilitated access and communication, remote consultations risked depersonalisation, particularly when not balanced with in-person interactions. Self-monitoring and access to information empowered patients and promoted more equitable patient-provider relationships.

Conclusions: Digital health technology can either strengthen or weaken patient-provider relationships in respiratory care, with effects impacted by adoption factors, confidence in technology, connection, and patient empowerment. Maintaining trust in the era of digital care requires transparent implementation of motivations, consideration of individual circumstances, and reliable technology that supports rather than replaces the therapeutic relationship.

Rights

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

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DOI

https://doi.org/10.2196/70970

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https://www.research.ed.ac.uk/en/publications/dc683059-e27b-4c6d-b890-7fef26bb1190