Clinic-level digitalisation and patient-reported experiences in Swedish primary care: a longitudinal observational study

In recent years, healthcare systems around the world have begun to weave digital tools into the daily fabric of medical care. Patients can now book appointments online, chat with doctors through secure messages, and even consult via video call, all without leaving their homes. This shift is part of a larger movement called digitalisation, where technology is used to change how services are delivered. While these tools promise to make care more convenient and accessible, they also bring uncertainty. When a clinic changes how it works, does it help everyone, or just the people who use the new technology? Does it free up time for doctors to listen better, or does it create new paperwork and confusion? Understanding these broader effects is crucial because the goal is not just to add gadgets, but to improve the quality of life for patients and the efficiency of the entire system.

To answer these questions, researchers in Sweden looked at what happened across hundreds of primary care clinics over four years, from 2019 to 2022. They wanted to see if the amount of digital contact a clinic used was linked to how satisfied patients felt about their care. Instead of asking individual patients how they liked a specific video call, the team examined the big picture. They gathered data from nearly half a million survey responses collected from patients across the country. These surveys asked people about their experiences, such as whether they could see a doctor in a reasonable amount of time or if they felt their medical needs were met. The researchers matched these feelings with hard numbers from clinic records, specifically tracking the percentage of all patient visits that happened digitally. This approach allowed them to see if clinics that increased their digital use over time also saw changes in how their patients rated the overall service.

The study covered a period of rapid change, starting just before the global pandemic and continuing through it. During these years, the use of digital contacts in Swedish primary care grew significantly, rising from a tiny fraction of 0.3 percent of all visits to 3 percent by the end of the study. This was a tenfold increase, driven largely by the need to stay connected while physical distancing was necessary. However, the overall mood of the patients did not follow the same upward trend. In fact, when looking at the entire four-year period, patient satisfaction scores for both access to care and the quality of treatment actually declined. This drop was statistically significant, meaning it was a real change and not just random fluctuation. The researchers noted that satisfaction had briefly improved in 2020, likely due to the initial shift in how people viewed healthcare during the crisis, but this gain was not sustained, and scores fell below pre-pandemic levels by 2022.

Despite this general decline in satisfaction, the researchers found a specific and surprising connection when they looked at how individual clinics changed over time. They discovered that clinics which increased their share of digital contacts the most also saw a corresponding rise in how patients rated their ability to access care. This finding held true even after the team accounted for other factors, such as the size of the clinic, the number of staff, and the health needs of the local population. The data suggested that as a clinic adopted more digital tools, its patients felt they could reach the health center within a reasonable time more easily. This link was statistically significant for the question about access, but it did not appear for questions regarding the actual treatment or care received. In other words, the digital shift seemed to help patients feel they could get in touch with the system, but it did not necessarily change their feelings about the medical advice or treatment they received once they were there.

The researchers also explored whether this relationship was different for clinics that were already struggling versus those that were performing well. They found that the negative association between digital contact and patient experience was strongest in clinics where patients were already giving low scores. In clinics where patients were already very satisfied, the link was weaker. This pattern suggests that clinics facing organizational challenges, such as long wait times or high workloads, might have turned to digital tools as a way to cope. It does not mean that the digital tools caused the low satisfaction; rather, it implies that clinics with existing problems were the ones most likely to increase their digital use in an attempt to manage the pressure. The study could not prove that digitalisation caused better or worse outcomes, but it did show that the two were moving together in specific ways.

One important detail from the study is the scale of the change. Even though the relative increase in digital contacts was huge, the absolute number remained small. By 2022, digital contacts still made up only 3 percent of all patient interactions. This means that for every 100 people visiting a clinic, only three did so through a digital channel. The fact that a measurable change in patient satisfaction was detected despite this small share suggests that the effects of digitalisation might ripple through the entire clinic, affecting even those who visit in person. It is possible that by moving some interactions online, clinics freed up time or resources that improved the flow for everyone, or perhaps the digital tools helped manage the overall demand better. However, the study also highlighted that if digitalisation increases the workload for staff or creates new administrative burdens, those negative effects could offset any benefits.

The authors concluded that while digitalisation appears to be linked to better feelings about access, it does not seem to be linked to feelings about treatment. This distinction is vital for policymakers and healthcare leaders. It suggests that the value of digital tools in primary care may lie more in how they help patients reach the system than in how they change the clinical encounter itself. The study also emphasized that these findings are specific to the Swedish context and the particular way digital services were implemented there. The researchers noted that more work is needed to understand how these tools affect the daily workload of staff, the fairness of care for different groups, and the long-term quality of treatment. They warned that without careful management, digitalisation could lead to increased stress for healthcare workers, which would eventually harm the patient experience.

Ultimately, this research provides a clear, data-driven look at how a healthcare system evolves when it embraces new technology. It shows that the story of digitalisation is not simply about replacing face-to-face visits with screens, but about how those screens change the rhythm and organization of a clinic. The results suggest that while patients felt they could get in touch more easily as digital use grew, their overall satisfaction with the care they received continued to face challenges. The study serves as a reminder that technology is just one part of a complex system, and its success depends on how well it is integrated into the daily lives of both patients and the people who care for them.