Primary care physician and nurse practitioner perspectives on digital self-triage patient navigator tools: Lessons from Ontario for future design and acceptance

Aim: To explore Ontario primary care physician and nurse practitioner experiences with, and perceptions of, digital self-triage patient navigator tools, and to identify implications for future design and implementation. Background: Purported benefits of digital self-triage tools include triage any time/place, easily updated triage logic, and reduced primary care demand. The COVID-19 pandemic provided a particularly important context for studying digital self-triage; primary care clinicians are an important group to learn from, but their perspectives have received little attention. Methods: We interviewed fourteen Ontario family physicians/nurse practitioners in Spring 2021 using semi-structured interviews. We asked about experiences with, and perceptions of, digital self-triage tools, including the provincial centralized tool. Interview data were analyzed using reflexive thematic analysis. Findings: Participants had limited awareness of the provincial tool. They had greater awareness of locally developed tools that were intended to mimic provincial logic, but that were integrated into primary care. Respondents noted local tools were embedded in EMR systems, enabled scheduling, and were designed by others they knew and trusted. Respondents preferred self-assessment tools positioned as adjuncts to, rather than replacements for, clinical care, due to concerns about coordination and continuity of care. Concerns centred on tool efficacy, user input and interpretation, and access and equity. Conclusions: This study highlights a gap between stand-alone digital self-triage tools (meant to reduce demand on primary care) and primary care. Locally developed tools intended to mimic that centralized tool, but integrated into primary care, are preferred. This aids primary care coordination and workflows but undermines ability to provide standardized triage anywhere, at any time, via a centralized tool, key benefits of digital self-triage. Future self-triage tools may be more effective if centrally maintained, but interoperable with local systems, developed with physician input, and customizable to support clinical workflows and continuity of care.