Local Keynote

Prof. Cecilia Björkelund

Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Don´t get lost in translation of e-health to the real world general practice!

It is important that the e-health implementation is developed to fit into the primary care and general practice context, and not the other way round. The development should be in cooperation, where general practice and the patients are the stakeholders and show the direction.

The way to take a cooperative responsibility is to assert primary care and the users – our patients - already in the development and implementation phase of eHealth. General practice has a great responsibility to claim that an eHealth treatment programme or a  support programme – which most of eHealth apps are – should be implemented in primary care by the way of research activities. This could preferably be made as a method development programme, where the first part is a randomized controlled study performed in the primary care context. Many developers should object to that, arguing that this would take too long and cost too much. However, we really need support for this claim of evidence, which is already an obvious demand for other parts of health care treatment and support methods. In Great Britain, NHS Digital has presented robust standards for the development of safe software, apps and IT systems and for deploying and operating such systems within the health and care environment.

For general practice/primary care the implementation of effective internet based treatment programmes and health apps is of great importance – but the effectiveness must be evaluated in several ways: Effectiveness for the patient, effectiveness for health care, and effectiveness for society. This means that we as general practitioners and health care workers must design studies that make both implementation and evaluation as effective as possible to be able to reach all goals. And in all this strain to reach highest effectiveness we must never underestimate the utmost therapeutic effectiveness of the patient/person centred consultation and continuity of care.  

So what we in primary care/general practice can and must do is to claim the importance of standards for the development and treatment of safe software, apps and IT systems and claim that these devices should be developed in the primary care context with primary care and users/patients leading the research and development within primary care. There are several ways to design research studies to evaluate eHealth effectiveness in comparison to effectiveness of the real world GP consultation - and the lecture will give examples of feasible primary care study designs, facilitating adequate implementation in many ways.