Barriers and enablers to sustaining hybrid care beyond the pandemic: lessons from the RAPIDE project

Abstract Background Hybrid care models combining remote and in-person delivery were widely adopted during COVID-19, especially for managing chronic conditions like type 2 diabetes and heart failure. While effective during the pandemic, these models proved difficult to sustain. We explored why hybrid care was not maintained post-pandemic and what is needed to support its long-term use in both emergencies and routine care. Methods Interviews with 26 healthcare professionals and stakeholders (GPs, specialists, patient representatives, and public health officials) in seven European countries explored barriers to service delivery and access. Results Hybrid care was introduced rapidly but lacked infrastructure, training, and policy support for sustained use. Clinicians lacked guidance on remote consultations, or criteria for choosing remote vs in-person care, leading to variation in practice, increased workload, and care quality concerns. Data protection rules limited use of familiar tools, while approved platforms were unreliable, poorly integrated with clinical systems, or difficult for patients to use-particularly affecting older adults, migrants, and those with limited digital literacy. Despite challenges, hybrid care had benefits in specific contexts. Phone calls worked well for low-complexity follow-ups, especially when patient-provider relationships existed. Nurse-supported remote care enabled symptom management and medication changes, with some models combining in-person nursing care while doctors assisted remotely. Proactive outreach, triage, and collaboration with pharmacists and community services also supported continuity, though often ad hoc and short-term. Conclusions Hybrid care met an urgent need during the pandemic but was not designed for the long term. To be sustainable, it must be embedded into health system planning, supported by investment in integrated digital infrastructure, clear clinical guidance, user-friendly tools, and equitable access to digital services.