Geva Greenfield

Background: Virtual consultations (VCs), including telephone and video consultations, are increasingly central to primary care. However, evaluation often prioritizes patient satisfaction or technology over quality and safety. Existing frameworks incorporate limited input from general practitioners (GPs) and lack standardized quality and safety indicators. Objective: This study aimed to explore GPs’ perspectives on the relevance and usability of a prototype tool for evaluating the quality and safety of VCs and to inform its subsequent refinement and development. Methods: A total of 3 online focus groups (N=14 GPs) were conducted in June 2025. Participants were recruited via professional networks and social media using convenience and snowball sampling. Discussions were guided by a mock tool prototype and a structured topic guide. Transcripts were analyzed inductively after each focus group using a combined deductive and inductive approach by 2 independent researchers. Results: GPs considered the tool relevant and timely, particularly as a reflective and quality improvement resource for early-career clinicians. For usability, participants preferred a combination of Likert scale and open-ended responses, emphasizing local adaptability and integration into existing workflows to minimize burden. Suggestions for practical implementation included a web-based format linked to electronic health records and alignment with professional development or incentive schemes (eg, the Quality and Outcomes Framework). Conclusions: GPs supported a structured yet flexible VC evaluation tool that is user-centered, locally relevant, and embedded within routine practice. These findings provide a foundation for further refinement, usability testing, and real-world piloting to ensure safe and high-quality VCs in primary care.

Objectives Structured medication reviews (SMRs) in primary care offer a patient-centred approach to optimising medicines for adults with multimorbidity and polypharmacy, but their effect on endpoint outcomes is not yet well-established. This review summarises their impact on these outcomes and on medicines optimisation, while also highlighting common delivery methods (in-person or remote). Design Systematic review using narrative synthesis. Data sources Ovid MEDLINE, Ovid EMBASE, Web of Science and CINAHL via OVID were searched for studies published between January 1997 and August 2025. Eligibility criteria Studies of adults with multimorbidity and polypharmacy receiving an SMR in primary care, compared with usual care. Randomised controlled trials, non-randomised controlled trials, cohort and cross-sectional designs were eligible. Data extraction and synthesis Two reviewers independently screened studies; one reviewer extracted data and a second verified them. Study quality was assessed using the National Heart, Lung, and Blood Institute quality assessment tools. Findings were synthesised narratively. Results Nine studies (8213 participants) assessed SMRs in relation to physical health (n=5), functional status (n=5), safety (n=2), healthcare utilisation (n=7), cost-effectiveness (n=3) and person-centred outcomes (n=3). Most reported no changes in physical health and falls (n=5), with no improvement in functional status (n=5). Safety outcomes showed no differences in survival or mortality (n=2). Healthcare use was largely unchanged (n=7), with only one study reporting fewer medication-related admissions. Person-centred outcomes remained unchanged (n=2). Cost outcomes were favourable, with savings (n=3) and quality-adjusted life year gains (n=2). SMRs were associated with prescription changes (n=4), reduced inappropriate prescribing (n=3) and improved adherence (n=2), although several between-group comparisons showed no significant differences. SMRs were usually delivered by general practitioners, pharmacists or multidisciplinary teams to older adults, although the mode of delivery (in-person or remote) was often unclear. Conclusions SMRs showed little effect on endpoint outcomes, but most studies focused on prescribing rather than clinical effects, limiting this conclusion. Realising their potential requires supportive policy and collaborative practice. Unclear delivery methods hinder evaluation, and as primary care adopts digital solutions, further research on remote SMRs is needed. Trial registration number PROSPERO CRD42023454965.

Background High-quality primary care can improve multimorbidity management but little evidence is available to understand its impact on secondary care use over time. Aim To assess the concurrent and lagged associations between quality of primary care and planned and unplanned secondary care use, examining the modifying role of frailty. Design and Setting A retrospective cohort study included 468,172 patients with multimorbidity in England from the Discover research platform (April 2022-March 2024). Method We used principal component analysis to combine a set of quality indicators (QIs) and assessed the impacts of QIs on both planned and unplanned care using regression models. Results Generally, patients with higher QI attainment also had higher likelihood of outpatient visits, emergency admissions and ED visits. There was a lower lagged odds of elective hospital admissions in the following 12 months among those with higher attainment of multimorbidity-specific QIs. In the complex multimorbidity cohort (≥3 conditions), multimorbidity-specific QIs were longitudinally associated with lower odds of elective admissions and outpatient visits, while generic QIs were related to lower odds of outpatient non-attendance. Conclusion Attainment of generic and multimorbidity QIs was generally associated with slightly increased planned and unplanned care. However, patients for whom we identified higher attainment of multimorbidity-specific QIs had lower odds of elective admissions and outpatient visits, especially for those with complex multimorbidity. Our research suggests that the quality of primary care may influence patients’ use of secondary care, with the potential to improve care for people with multimorbidity and warrant further investigation into management strategies.

BACKGROUND Dementia is a progressive, largely irreversible clinical condition, characterised by a global deterioration in cognitive function, behaviour and personality. The worldwide prevalence of dementia is expected to rise to over 150 million by 2050 (1), giving a 42% lifetime risk of dementia after 55 years of age (2). Digital health interventions offer a promising solution for safe, effective care, providing remote support, to enhance cognition, quality-of-life, physical, psychological and social wellbeing in dementia and mild-cognitive impairment (MCI). OBJECTIVE This systematic review evaluates the impact of digital health interventions in the form of mobile applications on individuals with dementia and MCI, living at home. METHODS A systematic search of six databases (Ovid MEDLINE, Ovid EMBASE, PsycINFO, CINAHL, CENTRAL, Scopus) was conducted. Peer-reviewed, primary studies of mobile applications for dementia and MCI care, published after 1st January 2020 were included. Interventions used outside the home, by caregivers, or solely for clinical assessment or diagnostic screening were excluded. Title and abstract screening was undertaken by two independent reviewers, data was extracted using Covidence, and quality appraisal was undertaken with the Cochrane Risk of Bias (RoB2) and National Heart, Lung and Blood Institute (NHLBI) tools. RESULTS Of 1642 studies screened, sixteen met the inclusion criteria. Nine examined the feasibility and acceptability of mobile health apps in dementia and MCI (3–12), five cognitive outcomes (13–17), five quality-of-life outcomes (8,9,13,14,18), three social, communication or carer relationships (8,9,13), two psychological outcomes (5,13), and two physical outcomes (13,14). All studies of cognition reported significant improvements, with increased MMSE scores at weeks 4 (OR 2.03, 95% CI 1.26–2.81) and 8 (OR 2.70, 95% CI 1.76–3.64). Mobile applications reduced caregiver burden (p=0.003), enhancing communication, warmth, affection, and mutuality. Reduced depression (SGDS, p=0.001; CSDD, 7.0 to 5.8), behavioural and psychological symptoms (NPI-K, 12.2 to 8.4), improved physical function (TUG, p<0.001; Cohen’s r=0.36) and nutrition (MNA, p=0.022) were observed. Quality-of-life outcomes were inconsistent across studies. CONCLUSIONS Mobile digital health apps are acceptable and useful to individuals with dementia and MCI with short-term positive outcomes across a range of cognitive, physical and psychosocial outcomes. Future research should include longer follow-up periods, cost-effectiveness analyses and consistency in intervention design and outcome measurement to better inform clinical practice and policy. CLINICALTRIAL PROSPERO: CRD420251139512 INTERNATIONAL REGISTERED REPORT RR2-10.2196/preprints.104640

Digital health literacy (DHL), the ability to seek, understand, and apply digital health information, is increasingly important in the United Kingdom, with a focus on digital transformation within the health service. While digital tools offer potential to improve access and equity, they may exacerbate existing health inequities if segments of the population are unable to engage with them effectively. Understanding the sociodemographic, economic, and social factors associated with DHL is essential to designing inclusive digital health services. This study aimed to measure DHL among UK adults and identify its sociodemographic, economic, and social associates. A cross-sectional online survey was disseminated to a nationally representative sample of UK adult internet users from November to December 2024. DHL was self-reported using the validated eHealth Literacy Scale (eHEALS), which ranges from 8 to 40. eHEALS score was dichotomized into high and low DHL based on a cutoff of 26. Multivariable logistic regression was used to identify associates of DHL, with missing data handled using multiple imputation by chained equations. The median eHEALS score was 31 (IQR 27-32); 21% (320/1525) of the participants had low DHL, while 79% (1205/1525) had high DHL. Those aged 65 years and older, compared with those in the age group of 18-44 years, had higher odds of low DHL (odds ratio [OR] 1.43, 95% CI 1.02-2.01; P=.04). Those belonging to a lower social grade also had higher odds of low DHL, compared with those belonging to the higher social grade (OR 1.37, 95% CI 1.05-1.80; P=.02). Females had lower odds of low DHL (OR 0.60, 95% CI 0.46-0.77; P<.001), as did those with an undergraduate or postgraduate degree or higher, compared with those educated to below degree level (undergraduate degree OR 0.52, 95% CI 0.37-0.74, P<.001; postgraduate degree or higher OR 0.58, 95% CI 0.40-0.82, P=.002). Those who socialized daily, compared to those who did this never or rarely, had marginally lower odds of low DHL (OR 0.64, 95% CI 0.42-1.00; P=.05). In subgroup analysis among participants with chronic health conditions, age and social grade were not significant associates of DHL. Among UK internet users, male sex, lower educational attainment, lower social grade, less frequent socializing, and older age were statistically significant associates of low DHL. The model's modest explanatory power suggests that additional factors beyond those examined play an important role. As findings are based on internet users, the prevalence of low DHL in the general population is likely higher than reported. This study provides a partial basis for identifying groups who may benefit from additional support, but intervention design should not rely solely on factors identified here. Inclusive interventions accounting for a broader range of factors are needed to ensure that digital transformation in health care narrows rather than widens health inequities.

Background: Diabetes during pregnancy, whether gestational diabetes mellitus (GDM) or pre-existing diabetes mellitus (DM), is associated with increased maternal and neonatal risks. Remote care has shown promise in managing diabetes in the general population, however, its impact on the quality of antenatal care for pregnant women with diabetes remains unclear. Considering the growing adoption of remote care globally, it is vital to understand its impact on the quality of care. This review aims to evaluate the impact of remote care on the quality of care for pregnant women with diabetes. This manuscript describes the protocol for the review. Methods: MEDLINE, EMBASE, CINAHL, MIDIRS, Scopus, Cochrane, and Global Health databases will be searched to identify studies published from 2005 to 2025. Eligible studies will include original empirical research, encompassing both interventional (e.g. randomised controlled trials) and observational designs (e.g. cohort and cross-sectional studies), assessing remote care, including both virtual consultations and remote monitoring, for pregnant women with GDM, Type 1 or 2 DM. Quality of care will be assessed using the Institute of Medicine healthcare quality framework: patient-centredness, effectiveness, safety, efficiency, timeliness, and equity. Screening and data extraction will be conducted by two independent reviewers. The quality of the studies will be assessed using the Cochrane Risk of Bias tools. Subgroup analyses will be undertaken to explore variation by diabetes and intervention type. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) guideline. Discussion: The findings of this review will provide evidence on the impact of remote care on the quality of care for pregnant women with pre-existing DM and GDM. Strengthening the evidence will support the development of evidence-based implementation strategies and inform policy decisions to ensure safe, effective, and patient-centred use of remote care interventions. Systematic review registration: PROSPERO CRD420251024685.

BACKGROUND Dementia is a progressive, largely irreversible clinical condition, characterised by a global deterioration in intellectual function, behaviour and personality. The worldwide prevalence of dementia in 2025 was 55 million people and is expected to rise to over 150 million by 2050, giving a 42% lifetime risk of dementia after age 55 years. Digital health interventions offer a promising solution for safe, effective care, providing remote cognitive, psychological and health promotion support, to reduce loneliness, improve wellbeing and enhance quality of life in dementia or mild-cognitive impairment (MCI). Research examining the comparative effectiveness, safety and impact on health outcomes is limited, however. OBJECTIVE This aim of this systematic review is to synthesize the evidence on the impact of mobile digital health applications for individuals with dementia or MCI. METHODS This review will include peer-reviewed, primary qualitative and quantitative research, on the impact of mobile digital health applications on individuals with dementia or MCI, published after 1st January 2020. Secondary reviews, meta-analyses, conference abstracts, editorials, and grey literature will be excluded. Ovid MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL and Scopus databases will be searched. Two independent reviewers will undertake title and abstract screening, data extraction and quality assessment using the Cochrane Risk of Bias (ROB2) tool, and the National Heart, Lung and Blood Institute (NHLBI) quality assessment tool. Discrepancies will be resolved by consensus. The protocol will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) guideline. RESULTS A narrative synthesis will be presented following standard guidelines. The review is expected to be completed by September 2026. CONCLUSIONS This review will provide an overview of the impact of digital health interventions in the form of mobile applications on individuals with dementia or mild cognitive impairment. It will inform future research and intervention studies on the impacts of mobile applications on the care of adults with dementia or mild cognitive impairment, to optimize future care and policy. CLINICALTRIAL Prospero Registration Number: CRD420251139512

BACKGROUND Continuous glucose monitoring (CGM) offers clinical and behavioural benefits for people with type 2 diabetes (T2D), including improved glycaemic control and enhanced self-management. However, important evidence gaps remain regarding whether CGM use is equitably distributed across patient groups and whether OBJECTIVE To examine the relationship between CGM use among individuals with type 2 diabetes (T2D) and a range of patient characteristics, including socio-demographic factors linked to health inequities, digital health literacy, clinical characteristics, and service utilisation. METHODS A cross-sectional online survey was conducted in November 2024 among adults in the UK with self-reported type 2 diabetes (T2D), recruited via the YouGov panel. The primary outcome was self-reported CGM use. Predictor variables included PROGRESS-Plus characteristics (age, gender, ethnicity, religion, education, occupation, household income, disability, and social engagement), digital health literacy (eHEALS scale), clinical characteristics (disease duration, current treatment, and complications), overall health status (number of long-term conditions), and healthcare utilisation (frequency of visits). Descriptive statistics and multivariable logistic regression were used to examine associations between CGM use and patient characteristics. RESULTS Among 403 participants, 12.7% reported CGM use. Nearly half of participants were aged 65 years or older, and 56.80% were male. Most participants were White 83.90% and lived in urban areas. Higher odds of CGM use were observed among insulin users (OR=3.80, 95% CI: 1.6–9.22, p<0.001). No other demographic, clinical, or service utilisation variables were statistically significantly associated with CGM use. CONCLUSIONS CGM use was primarily driven by insulin therapy, consistent with established clinical pathways within the National Health Service that prioritise access for this group. No significant variation was observed across demographic, socioeconomic, or health literacy-related characteristics, suggesting no clear evidence of inequalities in this sample. These findings indicate potentially equitable access, although further research in larger and more diverse populations is needed to confirm these patterns.

BACKGROUND Virtual consultations (VCs), including telephone and video consultations, are increasingly central to primary care. However, evaluation often prioritizes patient satisfaction or technology over quality and safety. Existing frameworks incorporate limited input from general practitioners (GPs) and lack standardized quality and safety indicators. OBJECTIVE This study aimed to explore GPs’ perspectives on the relevance and usability of a prototype tool for evaluating the quality and safety of VCs and to inform its subsequent refinement and development. METHODS A total of 3 online focus groups (N=14 GPs) were conducted in June 2025. Participants were recruited via professional networks and social media using convenience and snowball sampling. Discussions were guided by a mock tool prototype and a structured topic guide. Transcripts were analyzed inductively after each focus group using a combined deductive and inductive approach by 2 independent researchers. RESULTS GPs considered the tool relevant and timely, particularly as a reflective and quality improvement resource for early-career clinicians. For usability, participants preferred a combination of Likert scale and open-ended responses, emphasizing local adaptability and integration into existing workflows to minimize burden. Suggestions for practical implementation included a web-based format linked to electronic health records and alignment with professional development or incentive schemes (eg, the Quality and Outcomes Framework). CONCLUSIONS GPs supported a structured yet flexible VC evaluation tool that is user-centered, locally relevant, and embedded within routine practice. These findings provide a foundation for further refinement, usability testing, and real-world piloting to ensure safe and high-quality VCs in primary care.

Background: Virtual consultations (VC) are now integral to primary care delivery, but their implementation has been hampered by technological limitations, user engagement issues, and the lack of validated implementation frameworks.Objective: This study sought to identify and validate key elements required for the successful adoption of high-quality VC and to develop recommendations for its implementation in primary care.Methods: An electronic Delphi (eDelphi) study was conducted between March and December 2024 with Primary Care Physicians (PCPs) from 24 countries who had experience using VC in routine practice. Participants assessed 25 proposed toolkit components across six domains using a 5-point Likert scale. Descriptive statistics were applied, and consensus was defined as ≥70% agreement.Results: A total of 135 PCPs participated across three Delphi rounds. Consensus was achieved for 24 of the 25 framework elements. High priority was placed on long-term strategic planning and financial sustainability, sustained investment in VC infrastructure, enhanced cybersecurity and system resilience, improved digital literacy, and clear communication strategies for end-users. The sole component failing to reach consensus related to religious factors affecting VC acceptability, with most participants favouring inclusion of religion within broader cultural considerations rather than as a separate element.Conclusion: This study validated key components of a flexible VC implementation framework for primary care. The lack of consensus on certain contextual factors highlights the importance of culturally sensitive adaptation when implementing VC. Future work should focus on real-world piloting of the framework to evaluate its effectiveness at practice, policy, and system levels.