Digital primary and community healthcare: practitioner’s experience in Stockholm during the Covid-19 pandemic and future development

Background: Health care organizations report that that the Covid-19 pandemic accelerated their use of digital technologies. We wanted to better understand how rapid and large scale-up took place without any systematic implementation in public primary and community health care in the Stockholm region, Sweden, as well as future development plans. Methods: : Qualitative data from twelve focus group interviews with clinical managers (n=99) were analysed using a directed content analysis. The seven domains of the Non-adoption, Abandonment, and challenges to the Scale-up, Spread and Sustainability (NASSS) framework was used to understand the implementation process, as described by the clinical managers in the focus groups. Results: : The participants reported that they made their own local decisions to make more use of the existing technology provided by the health system for appointments, video and telephone calls. Most participants took the view that the technology was ready to use, despite some limitations. Most challenges for making more use of the technology that were reported were individual clinician’s and patient preferences, how ready their unit was for making changes to practice and organisation. Some raised concerns about how standardizing some aspects possibly conflicted with the decentralised management model of the organisation. The overall experience was reported to be positive, with an intention to sustain the achievements. Conclusions: : Focus group interviews found that that unit managers we re positive about the digital technology system for remote care. For the future, they wanted changes to be made at different levels of the health system to help them to better combine digital and physical care in their unit. Possibilities to use digital technology to integrate primary and hospital health care were identified.