Electronic Implementation of Patient-Reported Outcome Measures in Primary Health Care: Mixed Methods Systematic Review

Abstract

Background: Managing chronic diseases remains a critical challenge in primary health care (PHC) across the Organization for Economic Co-operation and Development countries. Electronic patient-reported outcome measures (ePROMs) are emerging as valuable tools for enhancing patient engagement, facilitating clinical decision-making, and improving health outcomes. However, their implementation in PHC remains limited, with significant variability in effectiveness and adoption.

Objective: This systematic review aimed to assess the implementation and effectiveness of ePROMs in chronic disease management within PHC settings and to identify key barriers and facilitators influencing their integration.

Methods: A mixed methods systematic review was conducted following the Cochrane Methods and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies that implemented ePROMs among adults for chronic disease management in PHC. The extracted data included patient health outcomes, provider workflow implications, implementation factors, and cost considerations. The reach, effectiveness, adoption, implementation, and maintenance framework was used.

Results: Our search yielded 12,525 references, from which 22 (0.18%) studies were included after screening and exclusions. These studies, primarily conducted in the United States (n=9, 41%) and Canada (n=8, 36%), covered various chronic diseases and used diverse ePROM tools, predominantly mobile apps (n=9, 41%). While some studies (n=10, 45%) reported improvements in patient health outcomes and self-management, others (n=12, 55%) indicated no significant change. Key barriers included digital literacy gaps, integration challenges within clinical workflows, and increased provider workload. Facilitators included strong patient-provider relationships, personalized interventions, and technical support for users. While some studies (n=10, 45%) demonstrated improved patient engagement and self-management, long-term cost-effectiveness and sustainability remain uncertain.

Conclusions: Success in implementing ePROMs in PHC 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 health care systems.

Trial registration: PROSPERO CRD42022333513; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022333513.

International registered report identifier (irrid): RR2-10.2196/48155.

Keywords: PRISMA; digital health; implementation science; patient-reported outcomes measures; systematic review.