The Impact of Digitalization on European General Practice From the Perspective of General Practitioners: Systematic Review.

Abstract

Digital health technologies, including telemedicine, electronic medical records, digital health tools (DHTs), and AI, are transforming European primary care, but evidence on how general practitioners (GPs) experience these tools remains fragmented. We aimed to synthesize European GPs' perspectives on the adoption and implementation of digital health technologies, focusing on perceived usefulness, ease of use, implementation barriers, workload, and doctor-patient relationships. We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and Synthesis Without Meta-Analysis guidance. Eight databases, PubMed, Scopus, SpringerLink, Wiley Online Library, Cochrane Library, Web of Science, Google Scholar, and Ovid, along with Elicit AI, were searched for primary studies on GPs' perspectives in European primary care, published in English or German between January 2014 and December 2024; a search update extended coverage to October 2025. Eligible qualitative, quantitative, and mixed methods studies reported GP-perceived adoption, implementation, or impact of digital tools. Risk of bias was assessed using the Mixed Methods Appraisal Tool and JBI (Joanna Briggs Institute) critical appraisal tools. Data were synthesized using a narrative synthesis framework by Popay et al and a combined technology acceptance model and normalization process theory (NPT) effect-direction approach. Of 1580 references, 65 studies including 24,994 GPs across 14 European countries (61/65, 93.8% from Western and Northern Europe) met the inclusion criteria. Studies covered AI or clinical decision support (n=7), DHTs (n=36), electronic medical records (n=4), and telemedicine (n=18). Perceived usefulness was high (56/65, 86.2% positive), whereas perceived ease of use was universally poor (0/65, 0% positive; 43/65, 66.2% negative), while actual use remained near universal (63/65, 96.9%). NPT constructs showed partial normalization: coherence 50.8% (33/65) positive; cognitive participation 4.6% (3/65) positive (22/65, 33.8%, negative); collective action 100% (65/65) partial; reflexive monitoring 66.2% (43/65) positive. Cross-cutting barriers included poor interoperability, fragmented platforms, limited training, misaligned incentives, and unreimbursed digital workload. GPs reported improved access for some patient groups but with concerns about depersonalized care and digital exclusion among older, low-literacy, rural, and socioeconomically disadvantaged patients. European general practice is extensively digitized but only partially normalized. GPs use digital tools because they must, not because they find them easy or workflow-enhancing. This review is, to our knowledge, the first to systematically synthesize European GPs' experiences of digitalization across multiple technologies using a combined technology acceptance model-NPT effect-direction approach. It identifies a quantifiable "implementation paradox" in which high perceived usefulness and near-universal use coexist with poor usability and only partial workflow integration. These findings highlight the need for interoperable, user-centered systems that replace rather than add tasks, reimburse digital workload, provide structured digital-competency training, and set governance frameworks that safeguard equity and the quality of remote care in everyday general practice.