Tag: Digital Health

Bridging the Digital Divide in Healthcare: Understanding the Use of the NHS App

The NHS App, launched in 2019, was designed to revolutionise how patients engage with their healthcare, offering features such as booking appointments, viewing medical records, and ordering prescriptions. While the app has seen substantial uptake—with millions registering and engaging—it appears that the benefits of this digital innovation are not evenly distributed across the population as we report in our article in the Journal of Medical Internet Research.

The Promise of the NHS App

Digital health tools like the NHS App hold the potential to empower patients, improve self-management of health, and increase access to care. From March 2020 to June 2022, millions of users logged into the app, ordered prescriptions, and accessed medical records. However, a closer look at the data reveals disparities in who is using these features.

The Digital Divide in Action

Our recent study highlights how sociodemographic factors influence app engagement. Key findings include:

  • Socioeconomic Disparities: People in more deprived areas are significantly less likely to use the app. For instance, the rate of app registrations was 34% lower in the most deprived practices compared to the least deprived.
  • Ethnic Differences: Practices serving populations with higher proportions of White patients showed far greater engagement. Prescription ordering rates in these areas were over double those in more ethnically diverse regions.
  • Age and Health Needs: Younger patients were more likely to use appointment booking features, while those with long-term conditions engaged more with medical record views and prescription services.
  • Gender Gaps: Practices with higher proportions of male patients reported lower app engagement overall.

Why Does This Matter?

The NHS App aims to make healthcare more accessible for all, but these disparities suggest that its benefits may not be reaching those who need them most. This mirrors the “digital inverse care law,” where digital solutions are disproportionately used by those with better access and resources, potentially exacerbating health inequalities.

How Can We Close the Gap?

To ensure the NHS App works for everyone, targeted efforts are needed:

  1. Digital Literacy Programmes: Equip underserved communities with the skills needed to navigate digital tools.
  2. Tailored Outreach: Highlight the App’s benefits to specific groups, such as ethnic minorities and those in deprived areas.
  3. Enhanced Support Services: Offer helplines or in-person assistance for individuals less familiar with digital health platforms.
  4. Collaborations with Community Groups: Partner with local organizations to raise awareness and build trust in digital healthcare solutions.

A Call for Inclusive Digital Health

The findings of our study underscore the importance of continuously monitoring and adapting digital health strategies to meet the needs of diverse populations. The NHS App is a powerful tool with the potential to enhance healthcare accessibility, but its success depends on equitable adoption and use.

Let’s work towards a future where digital health bridges gaps rather than widens them, ensuring better health outcomes for everyone, regardless of their background.

Streamlining Hypertension Care with the BP@Home Programme

The rapid shift towards digital health solutions, propelled by the COVID-19 pandemic, has underscored the critical need for innovative approaches to healthcare delivery in the UK’s NHS. The BP@Home initiative, as explored in our recent study published in the journal PLOS ONE, stands out as a beacon of such innovation, aiming to revolutionise hypertension management in primary care settings across London.

The initiative, a response to the pandemic-induced transition to remote healthcare, supports patients with hypertension in self-monitoring their blood pressure at home. This programme not only aims to maintain continuous care for high-risk patients but also addresses a long-standing challenge of hypertension management — a leading contributor to cardiovascular diseases globally – in trying to improve blood pressure control.

Barriers and Facilitators to BP@Home Implementation

Despite its promise, the BP@Home initiative faces significant hurdles, primarily stemming from resource constraints — including IT, human, and financial resources. Healthcare professionals (HCPs) involved in the program highlighted several barriers, such as the distribution and tracking of blood pressure monitors, a lack of clear guidance on their use, and the substantial workload without commensurate financial incentives.

Conversely, the study also identified facilitators that could smooth the path for BP@Home’s implementation. These include robust communication channels, task-sharing among healthcare teams, and the integration of the programme into daily clinical practice. Moreover, providing blood pressure monitors on prescription and leveraging the role of pharmacists emerged as practical strategies to address logistical challenges.

Towards a More Equitable and Efficient Healthcare Delivery

The insights garnered from the study illuminate the complex dynamics of implementing a remote healthcare initiative within an already stretched healthcare system. The recommendations put forth — centred on project management, logistics, engagement of primary care networks & practices, and patient engagement — offer a roadmap for overcoming the identified barriers.

The BP@Home initiative, by incorporating a person-centred approach and maintaining flexibility in patient engagement (including non-digital options), paves the way for a healthcare model that is not only responsive to the current COVID-19 pandemic but is also resilient in the face of future healthcare challenges.

A Call to Action for Future Healthcare Innovations

The successful implementation of BP@Home and similar initiatives requires a concerted effort from all stakeholders involved — from policy makers and healthcare managers to frontline health care professionals and patients . It highlights the importance of adapting healthcare delivery to meet the evolving needs of the population, leveraging technology to bridge the gap between patients and providers, and ensuring equitable access to healthcare services.

As we move forward, the lessons learned from BP@Home can inform the development of future healthcare innovations, emphasising the need for a healthcare system that is adaptable, patient-centric, and equitable. It is through such initiatives that we can hope to achieve a more sustainable and effective healthcare delivery model, capable of addressing the multifaceted health challenges of the 21st century.

Digital health: A greater focus on human factors is needed

There is growing appreciation that the success of digital health – whether digital tools, digital interventions or technology-based change strategies – is linked to the extent to which human factors are considered throughout the design, development and implementation. A shift in focus to individuals as users and consumers of digital health highlights the capacity of the field to respond to recent developments, such as the adoption of person-centred care and consumer health technologies.

In an article published in the journal BMC Medicine, we argue that this project is not only incomplete, but is fundamentally ‘uncompletable’ in the face of a highly dynamic landscape of both technological and human challenges. These challenges include the effects of consumerist, technology-supported care on care delivery, the rapid growth of digital users in low-income and middle-income countries and the impacts of machine learning.

Digital health research will create most value by retaining a clear focus on the role of human factors in maximising health benefit, by helping health systems to anticipate and understand the person-centred effects of technology changes and by advocating strongly for the autonomy, rights and safety of consumers.