The Role of Artificial Intelligence in Primary Care: A Systematic literature review

Titolo Rivista MECOSAN
Autori/Curatori Elisabetta Reginato, Isabella Fadda, Michela Floris, Paola Paglietti
Anno di pubblicazione 2026 Fascicolo 2025/134
Lingua Inglese Numero pagine 32 P. 77-108 Dimensione file 0 KB
DOI 10.3280/mesa2025-134oa22019
Il DOI è il codice a barre della proprietà intellettuale: per saperne di più clicca qui

Vedi l'articolo Scarica l'articolo open access

FrancoAngeli è membro della Publishers International Linking Association, Inc (PILA), associazione indipendente e non profit per facilitare (attraverso i servizi tecnologici implementati da CrossRef.org) l’accesso degli studiosi ai contenuti digitali nelle pubblicazioni professionali e scientifiche.

In recent years, Artificial Intelligence (AI) has opened new opportunities in primary care, from diagnosis and treatment planning to patient management.
However, concerns about fairness, equity, and ethics in healthcare arise. This study follows PRISMA guidelines to systematically review AI applications addressing these challenges.
It provides insights to guide future research and inform practices in primary care. The findings highlight significant theoretical and practical advancements in AI integration but also raise ethical concerns, particularly around data privacy and algorithmic bias. AI should complement, not replace, human healthcare professionals, requiring careful implementation to balance its benefits with potential risks.

Parole chiave:Artificial Intelligence;Primary care;Literature review;Applications;Equity;Ethical concerns

  1. Allen M. R., Webb S., Mandvi A., Frieden M., Tai-Seale M., Kallenberg G. (2024). Navigating the doctor-patient-AI relationship – a mixed-methods study of physician attitudes toward artificial intelligence in primary care. BMC Primary Care, 25(1): 42. DOI: 10.1186/s12875-024-02282-y
  2. Amisi J. and Downing R. (2017). Primary care research: does it defy definition?. Primary Health Care Research & Development; 18: 523-526. DOI: 10.1017/S1463423617000652
  3. Awofeso N. (2004). What is the difference between ‘primary care’ and ‘primary healthcare’?. Quality in Primary Care, 12(2): 93-94.
  4. Blease C., Kaptchuk T. J., Bernstein M. H., Mandl K. D., Halamka J. D., & DesRoches C. M. (2019). Artificial intelligence and the future of primary care: exploratory qualitative study of UK general practitioners’ views. Journal of medical Internet research, 21(3). DOI: 10.2196/12802
  5. Bohr A., Memarzadeh K. (2020). The rise of artificial intelligence in healthcare applications. In: A. Bohr, K. Memarzadeh (Eds.). Artificial Intelligence in Healthcare. Academic Press, pp. 25-60. DOI: 10.1016/b978-0-12-818438-7.00002-2
  6. Boscolo P. R., Lico K. (2020). L’emergenza diventa volano per l’intelligenza artificiale. Mecosan, 113: 129-137. DOI: 10.3280/MESA2020-113017
  7. Braun V., & Clarke V. (2012). Thematic analysis. In: APA Handbook of Research Methods in Psychology, Vol. 2, Research designs: Quantitative, qualitative, neuropsychological, and Biological (pp. 57-71). American Psychological Association. DOI: 10.1037/0000319-004
  8. Castonguay A., Wagner G., Motulsky A., Parè G. (2024). AI maturity in health care: An overview of 10 OECD countries. Health policy, 140. DOI: 10.1016/j.healthpol.2023.104938
  9. Clark C. R., Wilkins C. H., Rodriguez J. A., Preininger A. M., Harris J., DesAutels S., Karunakaram H., Rhee K., Bates D. W., & Dankwa-Mullan I. (2021). Health Care Equity in the Use of Advanced Analytics and Artificial Intelligence Technologies in Primary Care. Journal of General
  10. Internal Medicine, 36(10): 3188-3193. DOI: 10.1007/s11606-021-06846-x
  11. Cresswell K., Rigby M., Magrabi F., Scott P., Brender J., Craven C. K., Wong Z. S.-Y., Kukhareva P., Ammenwerth E., Georgiou A. (2023). The need to strengthen the evaluation of the impact of Artificial Intelligence-based decision support systems on healthcare provision. Health policy, 136, 104889. DOI: 10.1016/j.healthpol.2023.104889
  12. Davenport T., Kalakota R. (2019). The Potential for Artificial Intelligence in Healthcare. Future Healthcare Journal, 6(2): 94-98.
  13. Ford E., Milne R., & Curlewis K. (2023). Ethical issues when using digital biomarkers and artificial intelligence for the early detection of dementia. Wiley Interdisciplinary Reviews-Data Mining and Knowledge Discovery, 26. DOI: 10.1002/widm.1492
  14. Giest S.N., Klievink B. (2022). More than a Digital System: How AI Is Changing the Role of Bureaucrats in Different Organizational Contexts. Public Management Review, 1-20. DOI: 10.1080/14719037.2022.2095001
  15. Gurevich E., El Hassan B., El Morr C. et al. (2023). Equity within AI systems: What can health leaders expect?. Healthcare Management Forum, 36(2): 119-124. DOI: 10.1177/08404704221125368
  16. Hamet P., Tremblay J. (2017). Artificial intelligence in medicine. Metabolism – Clinical and Experimental, 69S: S36-S40. DOI: 10.1016/j.metabol.2017.01.011
  17. Holm S. (2023). Algorithmic legitimacy in clinical decision-making. Ethics and Information Technology, 25(3), 10. DOI: 10.1007/s10676-023-09709-7
  18. Kasteleyn M. J., Versluis A., van Peet P., Kirk U. B., van Dalfsen J., Meijer E., Honkoop P., Ho K., Chavannes N. H., & Talboom-Kamp E. P. (2021). SERIES: eHealth in primary care. Part 5: A critical appraisal of five widely used eHealth applications for primary care – opportunities and challenges. European Journal of General Practice, 27(1): 248-256. DOI: 10.1080/13814788.2021.1962845
  19. Khanassov V., Pluye P., Descoteaux S., Haggerty J.L., Russell G., Gunn J., Levesque J.F. (2016). Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review. European Journal of General Practice, 27(1): 248-256. DOI: 10.1080/13814788.2021.1962845
  20. Kretzschmar K., Tyroll H., Pavarini G., Manzini A., Singh I., NeurOx Young People’s Advisory Group (2019). Can Your Phone Be Your Therapist? Young People’s Ethical Perspectives on the Use of Fully Automated Conversational Agents (Chatbots) in Mental Health Support. Biomedical Informatics Insights, 5, 11. DOI: 10.1177/1178222619829083
  21. Kueper J.K., Terry A.L., Zwarenstein M., Lizotte D.J. (2020). Artificial intelligence and primary care research: a scoping review. Annals of Family Medicine, 18: 250-8. DOI: 10.1370/afm.2518
  22. Liaw W., Kakadiaris I.A. (2020). Artificial intelligence and family medicine: better together. Family Medicine; 52: 8-10. DOI: 10.22454/fammed.2020.881454
  23. Liaw S. T., Liyanage H., Kuziemsky C., Terry A. L., Schreiber R., Jonnagaddala J., & de Lusignan S. (2020). Ethical Use of Electronic Health Record Data and Artificial Intelligence: Recommendations of the Primary Care Informatics Working Group of the International Medical Informatics Association. Yearbook of medical informatics, 29(1): 51-57. DOI: 10.1055/s-0040-1701980
  24. Liaw W., Kueper J.K., Lin S., Bazemore A., Kakadiaris I. (2022a). Competencies for the Use of Artificial Intelligence in Primary Care. Annals of Family Medicine; 20: 559-563. DOI: 10.1370/afm.2887
  25. Lin S. Y., Mahoney M. R., & Sinsky C. A. (2019). Ten ways artificial intelligence will transform primary care. Journal of General Internal Medicine, 34: 1626-1630. DOI: 10.1007/s11606-019-05035-1
  26. Lu J., Sattler A., Wang S., Khaki A. R., Callahan A., Fleming S., Fong R., Ehlert B., Li R. C., Shieh L., Ramchandran K., Gensheimer M. F., Chobot S., Pfohl S., Li S. Y., Shum K., Parikh N., Desai P., Seevaratnam B., Hanson M., Smith M., Xu Y. Z., Gokhale A., Lin S., Pfeffer M. A., Teuteberg W. and Shah N. H. (2022). Considerations in the reliability and fairness audits of predictive models for advance care planning. Frontiers in Digital Health, 4, 25. DOI: 10.3389/fdgth.2022.943768
  27. Manne R. and Kantheti S. C. (2021). Application of Artificial Intelligence in Healthcare: Chances and Challenges. Current Journal of Applied Science and Technology, 40(6): 78-89. DOI: 10.9734/cjast/2021/v40i631320
  28. Muldoon L., Hogg W. and Levitt M. (2006). Primary care (PC) and primary health care (PHC): what is the difference?. Canadian Journal of Public Health, 97: 409-11. DOI: 10.1007/bf03405354
  29. Nundy S., Cooper L.A., Mate K.S. (2022). The quintuple aim for health care improvement: A new imperative to advance health equity. JAMA, 327(6): 521-522. DOI: 10.1001/jama.2021.25181
  30. Page M. J., McKenzie J. E., Bossuyt P. M., Boutron I., Hoffmann T. C., Mulrow C. D., ... & Moher D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372. DOI: 10.1136/bmj.n71 | BMJ2021;372:n71
  31. Romero-Brufau S., Wyatt K. D., Boyum P., Mickelson M., Moore M., Cognetta-Rieke C. (2020). A lesson in implementation: A pre-post study of providers’ experience with artificial intelligence-based clinical decision support. International Journal of Medical Informatics, 137, 104072. DOI: 10.1016/j.ijmedinf.2019.104072
  32. Roppelt J. S., Kanbach D. K., Kraus S. (2023). Artificial intelligence in healthcare institutions: A systematic literature review on influencing factors. Technology in Society, 76: 1-12. DOI: 10.1016/j.techsoc.2023.102443
  33. Safdar N. M., Banja J. D., Meltzer C. C. (2020). Ethical considerations in artificial intelligence. European Journal of Radiology, 122, 108768. DOI: 10.1016/j.ejrad.2019.108768
  34. Secinaro S., Calandra D., Secinaro A., Muthurangu V., e Biancone P. (2021). The Role of Artificial Intelligence in Healthcare: A Structured Literature Review. BMC Medical Informatics and Decision Making, 21(1): 125. DOI: 10.1186/s12911-021-01488-9
  35. Sinsky C., Colligan L., Li L., Prgomet M., Reynolds S., Goeders L., Westbrook J., Tutty M., Blike G. (2016). Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med., 165: 753-60. DOI: 10.7326/m16-0961
  36. Starfield B. (1998). Primary care and its relationship to health. In: Primary Care. Balancing Health Needs, Services, and Technology. New York, NY: Oxford University Press, Inc. DOI: 10.1093/oso/9780195125429.003.0001
  37. Sunarti S., Fadzlul Rahman F., Naufal M., Risky M., Febriyanto K., e Masnina R. (2021). Artificial Intelligence in Healthcare: Opportunities and Risk for Future. Gaceta Sanitaria, 35: S67-70. DOI: 10.1016/j.gaceta.2020.12.019
  38. Topol E.J. (2019). High-Performance Medicine: The Convergence of Human and Artificial Intelligence. Nature Medicine, 25(1): 44-56.
  39. 1038/s41591-018-0300-7.
  40. Tranfield D., Denyer D., & Smart P. (2003). Towards a methodology for developing evidenceinformed management knowledge by means of systematic review. British Journal of Management, 14(3): 207-222. DOI: 10.1111/1467-8551.00375
  41. Upshaw T. L., Craig-Neil A., Macklin J., Gray C. S., Chan T. C. Y., Gibson J., Pinto A. D. (2023). Priorities for Artificial Intelligence Applications
  42. in Primary Care: A Canadian Deliberative Dialogue with Patients, Providers, and Health System Leaders. Journal of the American Board of Family Medicine, 36(2): 210-220. DOI: 10.3122/jabfm.2022.220171R1
  43. Vidal-Alaball J., Panadés Zafrab R., Escalé-Besab A., Martinez-Millanad A. (2023), The artificial intelligence revolution in primary care: Challenges, dilemmas and opportunities. Atención Primaria, 56(82). DOI: 10.1016/j.aprim.2023.102820
  44. Wahl B., Cossy-Gantner A., Germann S., Schwalbe N.R. (2018). Artificial intelligence (AI) and global health: how can AI contribute to health in resourcepoor settings?. BMJ Glob. Health, 3(4). DOI: 10.1136/bmjgh-2018-000798
  45. Wang J. X., Somani S., Chen J. H., Murray S., & Sarkar U. (2021). Health Equity in Artificial Intelligence and Primary Care Research: Protocol for a Scoping Review. JMIR Res Protoc, 10(9), e27799. DOI: 10.2196/27799
  46. World Health Organization (1978). Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September. -- Available online at: www.who.int/hpr/NPH/docs/declaration_almaata.pdf.
  47. Wu Y., Min H., Li M., Shi Y., Ma A., Han Y., Gan Y., Guo X., Sun X. (2023). Effect of Artificial Intelligence-based Health Education Accurately Linking System (AI-HEALS) for Type 2 diabetes self-management: protocol for a mixed-methods study. BMC Public Health, 23(1). DOI: 10.1186/s12889-023-16066-z
  48. Yang X., Wang Y., Byrne R., Schneider G., Yang S. (2019). Concepts of artificial intelligence for computer-assisted drug discovery. Chem. Rev., 119(18): 10520-10594. DOI: 10.1021/acs.chemrev.8b00728
  49. Younis H.A., Eisa T.A.E., Nasser M., Sahib T.M., Noor A.A., Alyasiri O.M., Salisu S., Hayder I.M. (2024). A Systematic Review and Meta-Analysis of Artificial Intelligence Tools in Medicine and Healthcare: Applications, Considerations, Limitations, Motivation and Challenges. Diagnostics, 14, 109. DOI: 10.3390/diagnostics14010109

Elisabetta Reginato, Isabella Fadda, Michela Floris, Paola Paglietti, The Role of Artificial Intelligence in Primary Care: A Systematic literature review in "MECOSAN" 134/2025, pp 77-108, DOI: 10.3280/mesa2025-134oa22019