Digital technology in primary healthcare service delivery can enhance accessibility, service delivery and health outcomes in rural populations. The objective of this systematic review is to review and synthesise the scope and impact of digital health technology innovations within rural primary healthcare settings.

Systematic review.

Articles published on PubMed, PsycINFO, Cochrane Central, SCOPUS, Web of Science, EMBASE and CINAHL between January 2013 and October 2025 were searched using key search terms.

Patient, intervention, context, outcome model criteria guided article eligibility. Included articles were undertaken in rural populations, used digital health technology for treatment or management, explored the impact of digital health technology on rural primary healthcare and reported on healthcare outcomes. Included articles were in the English language and presented peer-reviewed primary research.

Extraction was performed using a bespoke standardised template by multiple reviewers. Quality assessment was undertaken using the Mixed Methods Appraisal Tool. Descriptive analysis and conventional inductive content analysis were applied to quantitative and qualitative data, respectively. The review is written in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement guidelines.

66 studies were included in the review. Most studies were conducted in the USA (n=26). Most studies focused on adult patient populations, with limited representation of Indigenous (In=3) and paediatric populations (n=2). Telemedicine/telehealth interventions using audio, video or both were the most common (n=36). Remote patient monitoring or point-of-care testing was integrated into 21 studies. Physical health conditions, particularly diabetes (n=17), cardiovascular diseases (n=11) and general primary healthcare concerns (n=13) were commonly reported. Others reported on areas including mental health, hypertension, obesity and pregnancy care.

Conventional inductive content analysis identified key themes: cost and time effectiveness, quality healthcare provision, consumer acceptance from both patients and practitioners, and healthcare service provider perspectives. Uptake barriers included staff workload and patient non-compliance, while facilitators encompassed process standardisation and practitioner acceptance and endorsement. Consumer acceptance was linked to satisfaction, willingness to engage and improved health outcomes and well-being.

Digital health interventions in rural primary healthcare offer significant potential to improve healthcare delivery, reduce costs and enhance patient access, satisfaction and health outcomes. However, careful consideration of factors such as feasibility, consumer and practitioner acceptance, and recognition of limitations is crucial for successful implementation. The review underscores the importance of flexible policies to support emerging digital healthcare solutions, including the integration of artificial intelligence. Overall, digital health interventions offer a promising avenue to improve healthcare outcomes in rural areas and should be prioritised for government funding and investment.

CRD42023477233.

Telemedicine use has risen significantly since the COVID-19 pandemic. Evidence suggests that the quality of care in telemedicine could be as good as in-person care, but this is likely context-dependent. Expert guidelines have declared the appropriate medical conditions, but often without empirical evidence that grapples with the fundamental information limitations facing telemedicine. We draw on the task-technology fit theory and empirical evidence around human communication to examine how the medical and social contexts affect the efficiency and clinical quality of primary care.

We will use a population-based dataset from the Canadian province of British Columbia (BC) to inform a quasi-experimental study using propensity score matching (PSM). The treatment group will consist of telemedicine visits from April to December 2022. We will use PSM to create a control group of matched, in-person visits in the same period. We will then use cluster-robust linear regression to identify how specific medical conditions and social contexts are associated with higher rates of prescription, follow-up with primary care providers, emergency department visits and acute care admissions. We plan for the study to take place from 1 August 2025 to 1 August 2026.

The Research Ethics BC has granted approval for this study (H21-02244-A006). Our findings will be shared with patients, healthcare providers and policymakers and disseminated through conference presentations and peer-reviewed publications.