A scoping review was conducted to examine reports on health delivery modifications incorporating digital health components, which were introduced due to the COVID-19 pandemic to deliver nonpandemic health care services. The review was conducted as part of the Horizon Europe RAPIDE (Regular and Unplanned Care Adaptive Dashboard for Cross-Border Emergencies) project and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines [17] (Checklist 1). The research protocol was registered on the Open Science Framework Registries [18].

The main outcome of interest for included studies was modifications to health delivery involving a digital health intervention, implemented for the provision of nonpandemic care in the context of the COVID-19 pandemic in Europe. Evidence sources included peer-reviewed primary research studies. Aligned with this outcome and context, the following specific inclusion criteria were applied: (1) studies reporting primary data on the use of digital care modifications (ie, health care delivery modifications with digital health components), alongside descriptions of their implementation, intervention characteristics (eg, specific setting, patient groups, and clinical contexts), telehealth systems used, and their care functions; (2) studies describing digital care modifications introduced or scaled up in the context of the COVID-19 pandemic and aimed for nonpandemic care services; (3) studies focused on care for adult populations; and (4) studies reporting data from countries within the European Union, the European Economic Area, the Schengen area, or the United Kingdom.

In addition, the following exclusion criteria were considered: (1) non–peer-reviewed publications; (2) studies that did not separately report outcomes for eligible countries; (3) publications in a language other than English, Dutch, French, or Spanish; and (4) studies with a primary focus on mental health or pediatric health care. Studies with a focus on mental and pediatric care were excluded due to the distinct organization and service delivery models used in these types of care, as these studies would have introduced additional variability beyond the scope of this review.

A comprehensive search was initially conducted on May 22, 2024, and later updated on January 14, 2026. The following electronic databases were searched, without applying multidatabase searching: PubMed or MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Web of Science (Clarivate), and PsycINFO (Ovid). No other registries or online resources were consulted, and no additional data were sought through contacts. No additional information sources or search methods were used.

The search aimed to cover a broad range of literature, for which the concepts “delivery of health care,” “nonpandemic care,” and “COVID-19” were used to build the search strategy across all databases, including a combination of keywords and indexed vocabulary. No further limits, restrictions, or search filters were applied. No existing search strategies from other reviews were adapted or reused. The search was developed and reviewed by all authors in consultation with an information specialist, and no other external experts peer-reviewed the search. The original search strategy was reproduced for updating the search, which was consistent with the original search in all databases. The reproducible searches for all databases are available in Multimedia Appendix 1. Duplicates were removed by the researchers using EndNote (Clarivate) and Rayyan.ai (Qatar Computing Research Institute) deduplication features. All information related to the search used is reported in accordance to the PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension) [19] (Checklist 2).

A broad search was conducted with the aim of capturing the diversity of service delivery modifications. First, all studies describing service delivery modifications (both digital and nondigital) and meeting all other eligibility criteria were preliminarily included. Next, studies were categorized according to the types of service delivery modifications, and those applying digital care modifications were selected for inclusion. This approach ensured the selection of studies that addressed digital health as part of broader service modification, even if it was not the primary focus.

As part of the screening, a pilot was first conducted for title and abstract screening to ensure clarity among researchers regarding eligibility criteria. Title and abstract screening was conducted by 3 researchers (NSV, TVL, and LN), and 10.4% (798/7652) of the total records were screened by at least two researchers independently. Full-text screening was conducted by 2 researchers (NSV and LN), with 5% (32/641) of the records screened by both researchers independently. The remaining records were screened separately due to strong agreement in the pilot screening. Citation searching was conducted for review studies that met the initial inclusion criteria through a manual search of reference lists; cited studies were then individually screened for inclusion. All discrepancies were resolved by consensus. The web application Rayyan.ai was used to support the screening process.

A standardized data extraction form was developed and piloted among 3 researchers (NSV, TVL, and Dilek Yildirim), until agreement and consistency were reached. Studies were then split among the researchers who conducted the data extraction (NSV, TVL, and Dilek Yildirim). The online platform Airtable (Formagrid Inc) was used for data extraction, and Microsoft Excel was used to support additional data collation for reporting.

Data extracted included the year of publication, study design, country, health care discipline, level of care, pandemic period of study data, presence and type of evaluation, and characteristics of the digital care modifications (including telehealth systems, digital interventions, care functions, and in-person care components). Definitions for the uses of digital technology for health, including systems and interventions, were based on World Health Organization [3] and were used to inform both the terminology and categorization of digital components during data extraction and synthesis.

The methodological quality of the studies was appraised by 2 researchers (NSV and TVL) using the Mixed Methods Appraisal Tool (MMAT) [20]. The researchers independently rated a subset of 5 studies and aligned on the interpretation of criteria. The remaining studies were divided and separately appraised by the 2 researchers using a standardized form. Percentages of quality criteria met were calculated per study, and no studies were excluded based on methodological quality.

Descriptions of digital care modifications were inductively analyzed and used to create distinct digital flows, defined as the combination of 1 telehealth system, 1 digital intervention, and 1 care function (Table 1). Digital flows were constructed by the researchers based on descriptions of digital health modifications in each study. For studies describing several systems, interventions, or care functions, multiple digital flows were recorded. Digital care modifications were further categorized according to their hybrid care implementation, registering whether digital health was implemented as an individual approach (digital-only) or in combination with the provision of in-person care components (hybrid). Study evaluations of reported modifications were recorded following the Kirkpatrick model of evaluation, allowing multiple levels of evaluation, if applicable [21]. The Kirkpatrick model covers 4 distinct levels of evaluation and has been widely applied across health disciplines, allowing its pragmatic application across diverse outcomes as well as its straightforward interpretation [21].

In total, 7652 distinct studies were identified, of which 641 full texts were screened for eligibility. Studies included within identified reviews (n=18) were further screened for eligibility, resulting in 38 additional included studies. Finally, 189 studies met eligibility criteria and were included in the analysis (Figure 1).

Included studies were published between 2020 and 2025. Most studies were written in English (183/189, 96.9%), and several had full text available in Spanish (n=4) [22-25] and French (n=2) [26,27]. Over 80% (n=157) of the studies were either observational (n=79) or descriptive (n=78). The studies covered 23 distinct countries and 37 distinct health care disciplines across different settings, with a strong dominance of secondary and tertiary care (n=139) and nonsurgical disciplines (26/37, 70.3%). Data derived from the year 2020 were most frequently reported, and 114 studies exclusively covered data from February to June 2020. The studies’ characteristics are found in Table 2 (additional details provided in Multimedia Appendix 2).

Quality appraisal was conducted for 84.1% (159/189) of the studies, while 15.9% (30/189) comprised narrative accounts of care modifications and did not meet the MMAT screening criteria to be appraised. Nearly 60% (94/159) of the appraised studies met 80% or more of the quality criteria, and only a small number of studies (9/159) met 40% or less of the MMAT criteria.

This scoping review has provided a comprehensive examination of modifications involving hybrid care implemented during the COVID-19 pandemic to support nonpandemic care services. To our knowledge, this is the first review focusing on hybrid care modifications implemented throughout the entire pandemic period. During the COVID-19 pandemic, digital health was considerably scaled up to support the provision of nonpandemic care, which could be observed through frequent reports of digital health as a novel or upscaled application. By mapping digital flows, we were able to examine the diverse ways digital care modifications were implemented in practice, highlighting the importance of analyzing the different components involved in digital health implementation. Linked to digital flows, the limited number of telehealth systems supporting a variety of care functions underscores their practical versatility. This review not only examines the variety of telehealth systems, interventions, and care functions used in different health care settings but also expands the understanding of their implementation as part of hybrid care pathways.

Our findings show that digital health was commonly described as part of hybrid care provision, rather than standalone digital approaches. Central factors for implementation included the selection of patient groups, prioritization based on clinical condition and urgency, and availability of telehealth systems, which often defined the distribution and use cases of in-person and digital interventions. The diverse ways in which in-person and digital care were combined reflect the constant need for adaptation of care models throughout the pandemic and across health care settings. Previous experiences with specific health care settings and patient groups may point to necessary context-specific adaptations [170-172]. Also linked to the constant need for adaptation, the number of publications describing hybrid care modifications decreased throughout the years. This decrease may be partly reflective of the return to prepandemic care delivery but may also be related to a decrease in the reporting of novel care delivery modifications.

The creation of digital flows revealed the various ways digital health technologies were implemented during the pandemic. Notably, a few telehealth systems facilitated the application of numerous interventions and care functions. Online websites and platforms were more commonly reported than mobile technologies, which may have been linked to unclear reporting of which specific systems were used and whether overlaps with other systems were present. Similarly, reports of mobile technology application may have been limited to specific demographic groups, such as the younger population. The concomitant use of multiple telehealth systems may reflect efforts to target distinct care functions and different types of users. Evidence on disparities of technology adoption for different users, including older people and ethnic minorities [173,174], underscores the need for flexibility, adaptation, and consideration of access requirements in the implementation of models of care during emergency situations.

Emerging technologies using AI, such as virtual health assistants, were nearly absent in our findings. Previous studies indicate the use of these technologies during the pandemic was concentrated in areas other than direct nonpandemic care, such as diagnosis and detection of COVID-19 [175], which may also be related to their early stage of development, as well as regulatory barriers hindering wider adoption. As technology advances, it is expected that these types of interventions might take on a more prominent role in the future.

In contrast to telehealth systems, a wider variety of digital interventions was identified. The frequent use of telephones is in line with findings from previous studies [176,177] and may be associated with their familiarity, low cost, and ease of access for providers and patients. The common report of the use of video calls during the pandemic has also been previously reported in multiple health care contexts [177-179]. While text-based interventions have been examined in previous studies [176], more research may be needed to better understand their scope, especially in relation to other interventions such as those involving store-and-forward technologies.

Interventions were most commonly linked to follow-up care, aligning with studies from the first months of the pandemic [176,177,180]. Previous research has pointed out that remote care may yield more positive outcomes when patients have a pre-existing relationship with providers [181]. Distinguishing between new patients and follow-up or known patients may also be of value for assessing satisfaction with remote consultations [55,131]. The broad application of different interventions for follow-up care indicates great potential for enabling continuity of care for patients with chronic conditions, both during normal and crisis situations.

Additionally, our findings show that evaluations of modifications in the delivery of nonpandemic care were limited in scope. Over half of the included studies did not report any form of evaluation, and most of those that did focus on short-term user experiences rather than behavioral, clinical, or long-term implementation outcomes. Many of these care modifications were introduced rapidly as emergency responses to an evolving crisis, often without the time or infrastructure to plan for formal evaluation. Time pressure and resource scarcity during the pandemic, alongside the frequent ad hoc nature of modifications, may have contributed to the low number of evaluations.

Evaluations of patients’ and providers’ experiences and satisfaction align with previous studies, which have similarly centered on user acceptability and adoption [182] and have found high levels of satisfaction with digital health during the pandemic [183,184]. Behavioral and organizational outcomes also align with evaluations conducted before the pandemic, which have evaluated aspects such as behavior change, cost-effectiveness, and clinical and patient-centered outcomes [185]. Regarding clinical outcomes, previous evidence has shown clinical efficacy in the use of digital health interventions for a variety of patient groups [186,187], highlighting its relevance for remote care provision. Although less frequently found, evaluations conducted with the aim of exploring long-term implementation underscore the critical need for addressing sustainability in digital health implementation [188].

This review has applied a comprehensive and systematic methodological approach. However, some limitations are worth noting. Although the inclusion of solely peer-reviewed publications helped ensure rigor in the synthesized data, evidence reported through other means has not been included. Additionally, a publication bias may exist toward positive experiences with digital health, and less successful practices may be underrepresented. The variation in study designs, alongside the diversity of health care contexts and patient groups, may have influenced the interpretation of the findings. Future research may provide additional insights into which specific patient groups may benefit more from the implementation of hybrid care.

This review limited its scope to modifications directly related to service provision; however, other types of interventions, such as those for interprofessional collaboration or patient education, may also be valuable for improving timely access to high-quality care. Strategies to improve remote communication between primary and secondary care providers, as well as the implementation of remote multidisciplinary meetings, have shown potential to improve the organization of care and may be a focus for future research [34,42,75,80,99,121].

Moreover, differences in the use of terminology for digital health greatly contribute to diverse reporting of systems, interventions, and functions and may have influenced the reporting of results. Future research can benefit from using common terminology frameworks, increasing consistency in reporting and helping improve future understanding of the implementation and evaluation of digital and hybrid care. Such common frameworks may also be essential for the development of legal and regulatory procedures [180].

This review synthesizes findings essential for understanding the scope of hybrid care modifications used in the delivery of nonpandemic care and implemented throughout the COVID-19 pandemic. It provides a unique view as it analyzes digital health interventions as part of broader care pathways, which combine different types of care delivery implemented to sustain access to care. Integrating digital health as part of hybrid care models is essential in designing care pathways that can adapt to different contexts, including future health emergency situations.

The use of digital health and emerging technologies such as AI will continue to shape the future of health care delivery. As evidence regarding its applications advances, research should identify which combinations of digital interventions and care functions offer the greatest accessibility and cost-effectiveness. In the future, research may expand the application of hybrid care models to innovative strategies for the effective management of any crisis involving disrupted infrastructure. Policymakers, researchers, and implementers should also prioritize strategies to reduce inequities in access to digital and in-person care, particularly for underserved populations. Finally, evaluations should move beyond short-term user experiences and assess long-term implementation, clinical outcomes, and sustainability of hybrid care models.