Implementation of digital health interventions in primary care in high-income countries: a systematic review

Summary Digital health interventions are central to modernising health systems, yet implementation in primary care remains uneven. With primary care carrying growing responsibility for managing complexity, reducing inequities, and coordinating the increasingly digital care pathways, and health systems expecting to integrate artificial intelligence (AI) and other technologies into routine practice, understanding how digital health is implemented in this setting is pivotal to future system performance. In this systematic review, we synthesised evidence from high-income countries to identify what enables or impedes adoption of digital health interventions in real-world primary care settings and develop recommendations for stakeholder groups on implementing digital health in primary care settings. We analysed 204 empirical studies (published between Jan 1, 2020, and May 31, 2024) across 23 high-income countries using the Consolidated Framework for Implementation Research-informed coding and narrative synthesis. Across contexts, implementation hinged not on individual barriers but on the alignment of technological, organisational, and policy conditions. Digital health interventions were adopted when viewed as legitimate, evidence-based, usable, and offering clear clinical or operational advantage, supported by interoperable infrastructure, channel-neutral reimbursement, and an empowered workforce. Implementation stalled wherever digital tools added workload, financial and staffing support was inadequate, or information technology systems were fragmented. The COVID-19 pandemic showed the system’s capacity for rapid digital scale-up under permissive regulation, although many clinical and operational gains proved transient because of unsustainable implementation. Sustained digital transformation in primary care requires stable financing, interoperability, workforce capacity, and deliberate integration of digital health interventions into everyday care.