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Review
. 2025 May 30:27:e70970.
doi: 10.2196/70970.

Impact of Digital Health on Patient-Provider Relationships in Respiratory Secondary Care Based on Qualitative and Quantitative Evidence: Systematic Review

Michaela Senek #  1 , David Drummond  2 , Hilary Pinnock  3 , Kjeld Hansen  4 , Anshu Ankolekar  5 , Úna O'Connor  6 , Apolline Gonsard  2 , Oleksandr Mazulov  7 , Katherina Bernadette Sreter  8 , Christina Thornton  9 , Pippa Powell  4
Affiliations
Review

Impact of Digital Health on Patient-Provider Relationships in Respiratory Secondary Care Based on Qualitative and Quantitative Evidence: Systematic Review

Michaela Senek et al. J Med Internet Res. .

Abstract

Background: Digital health technology adoption has accelerated in respiratory care, particularly since the COVID-19 pandemic, supporting various applications from self-management to telerehabilitation. While these technologies have transformed health care delivery, their impact on the patient-provider relationship in specialist respiratory care remains poorly understood.

Objective: This study aims to systematically review the literature on the impact of digital health technology on the patient-provider relationship in respiratory secondary care settings and to understand the factors that enhance or diminish this relationship.

Methods: In December 2023, we conducted a systematic review following Cochrane methodology, searching MEDLINE, Embase, CINAHL, Cochrane databases, and PsycINFO. We included qualitative, quantitative, and mixed methods studies examining digital health interventions in respiratory secondary care. Trained volunteers from the European Respiratory Society CONNECT Clinical Research Collaboration performed screening and data extraction. We conducted a qualitative meta-synthesis of findings, followed by an abductive quantitative data analysis. A total of 3 stakeholder workshops were held to interpret findings collaboratively with patients and health care professionals.

Results: From 15,779 papers screened, 97 met the inclusion criteria (55 qualitative/mixed-methods studies, 42 quantitative studies). Studies covered various respiratory conditions, including COPD (32%), asthma (26%), and COVID-19 (13%). Four main themes emerged: trust (foundational to the relationship), adoption factors (including clinical context and implementation drivers), confidence in technology (based on functionality and the evidence base), and connection (encompassing communication and a caring presence). Digital health technology can either enhance or diminish trust between patients and clinicians, with patients' perceptions of the motivations behind its implementation being crucial. While technology facilitated access and communication, remote consultations risked depersonalisation, particularly when not balanced with in-person interactions. Self-monitoring and access to information empowered patients and promoted more equitable patient-provider relationships.

Conclusions: Digital health technology can either strengthen or weaken patient-provider relationships in respiratory care, with effects impacted by adoption factors, confidence in technology, connection, and patient empowerment. Maintaining trust in the era of digital care requires transparent implementation of motivations, consideration of individual circumstances, and reliable technology that supports rather than replaces the therapeutic relationship.

Trial registration: PROSPERO CRD42024493664; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024493664.

Keywords: digital health; patient-provider relationship; respiratory care; systematic review; telemedicine; trust.

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Conflict of interest statement

Conflicts of Interest: Author HP received a Teva Pharmaceuticals Speaker fee for a sponsored symposium and a Sandoz Pharmaceuticals Speaker fee for a sponsored symposium. All other authors listed no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.
Figure 2
Figure 2
Themes and subthemes.
See this image and copyright information in PMC

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References

    1. Pinnock H, Poberezhets V, Drummond D. Digital Respiratory Healthcare. Lausanne: European Respiratory Society; 2023. Introduction; p. 8.
    1. Future of digital health systems: report on the WHO symposium on the future of digital health systems in the European region. World Health Organization. 2019. [2019-02-06]. https://iris.who.int/handle/10665/329032 .
    1. Global diffusion of eHealth: making universal health coverage achievable: report of the third global survey on eHealth. World Health Organization. 2016. [2025-04-09]. https://www.who.int/publications/i/item/9789241511780 .
    1. Pérez Sust P, Solans O, Fajardo JC, Medina Peralta M, Rodenas P, Gabaldà J, Garcia Eroles L, Comella A, Velasco Muñoz C, Sallent Ribes J, Roma Monfa R, Piera-Jimenez J. Turning the crisis into an opportunity: digital health strategies deployed during the COVID-19 outbreak. JMIR Public Health Surveill. 2020;6(2):e19106. doi: 10.2196/19106. https://publichealth.jmir.org/2020/2/e19106/ v6i2e19106 - DOI - PMC - PubMed
    1. Digital Respiratory Healthcare. 2023. [2025-04-04]. https://www.ersbookshop.com/products/digital-respiratory-healthcare?srsl... .