Effectiveness of digital health interventions for chronic conditions management in European primary care settings: Systematic review and meta-analysis

Background: The past decade has seen rapid digitalization of healthcare, significantly transforming healthcare delivery. However, the impact of these technologies remains unclear, with notable gaps in evidence regarding their effectiveness, especially in primary care settings. Objective: This systematic review assesses the effectiveness of digital health interventions versus interventions without digital components implemented over the last 10 years in European primary care settings for managing chronic diseases. Methods: Following Cochrane guidelines, we conducted a systematic review with meta-analysis. We searched multiple databases for randomized controlled trials. Inclusion criteria encompassed studies on digital health interventions for chronic disease management in primary care settings in Europe, evaluating outcomes such as hospitalizations, quality of life, and clinical measures. Data extraction and quality assessment were independently conducted by two authors, with discrepancies resolved by a third author. The certainty of the evidence was judged according to the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: From 9829 records, 23 studies were included, with most studies conducted in the UK and Spain. The most investigated conditions were type 2 diabetes and hypertension. Interventions mainly focused on patient monitoring, self-care education, and digital communication tools. The risk of bias was low to moderate for most studies. Meta-analyses showed no significant differences between digital health interventions and usual care for hospitalizations, depressive symptoms, anxiety, HbA1c, diastolic blood pressure, weight, or quality of life, except for a small improvement in systolic blood pressure. Conclusion: Digital health interventions have not yet demonstrated substantial benefits over traditional care for chronic disease management in European primary care. While some improvements were noted, particularly in systolic blood pressure, the impact remains limited. Further research is needed to enhance the effectiveness of digital health interventions, address current methodological limitations, and explore tailored approaches for both specific patient populations and multimorbid populations.