Digital Health Technologies During COVID-19: A New Normal in Primary Health Care Delivery

Abstract The primary health care (PHC) in the Alma-Ata Declaration of 1978, revisited in the Astana Declaration of 2018, underpins the fundamental goal of achieving universal healthcare coverage. The 2019 coronavirus pandemic (COVID-19) shows that rapidly spreading outbreaks can significantly hamper the provision of PHC. This study investigates how digital health technologies (DHTs) evolved to support the PHC sector during COVID-19 and lessons for the future improvement of PHC. A systematic review was conducted through database searches (PubMed, Scopus, and Google Scholar) and hand-searching of grey documents published in English between December 2019 and December 2021. The study employed thematic content analysis and synthesis. The final synthesis included 46 documents: 40 articles; one book; two book chapters; one working paper; and two technical reports. Around 19 major theme categories were found, with the top three being the eHealth category, comprising themes like telemedicine, e-prescription, telepsychiatry, and telehealth visits; the mHealth category, such as App-based telemedicine and mobile electronic patient records connecting patients, physicians, and health systems; and the device category, such as wearable technologies, telemedical stethoscopes, telemedical ECGs, and remote monitoring devices. Finally, 20 areas of use of DHTs were identified and then grouped into five main areas: 1st) provision of health services, such as general care (teleconsultations, diagnosis, testing, etc.) and managing chronic conditions; 2nd) communicating, informing, and educating roles (e.g., preventing vaccine hesitancy) and digital health literacy; 3rd) monitoring and surveillance roles (e.g., symptoms’ monitoring); 4th) vaccination and drug purposes (e.g. e-prescription, adverse-drug-reaction monitoring, etc.); and 5th) enhancing system decision-making. DHTs have the potential to solve some of the challenges that have plagued us even before COVID-19. Therefore, this study puts forward recommendations to further stimulate the use of evidence based DHT, making it more inclusive, educative, and satisfying to people's needs, both under normal conditions and during outbreaks. More research is required, with a focus on quality assurance in the use of digital health; technical aspects (standards for digital health tools, infrastructure, and platforms); and financial perspectives (payment for digital health services and adoption incentives).