We consider what might be learned from the unintended, apparently unanticipated, consequences of the use of digital health (including alternatives to face to face consultations, electronic medical records, use of apps and online monitoring) in primary care. We chose a conceptual literature review method, to seek a higher order understanding of the nuanced patterning of unintended consequences of digital health technologies (for people, relationships, organisations and ways of working) which are rarely simply positive or negative. The approach is informed by realist review, which recognises that experiences and outcomes of interventions work (or fail) in different ways in particular contexts.

We present three higher order themes to illuminate underpinning mechanisms for unintended consequences in digital health technologies in primary care. These themes are illustrated by case examples, with particular focus on those that have been little discussed in the literature. Following Merton’s (1936) differentiation between consequences for the actor(s) and others, which are mediated through the culture and social structure, we discuss consequences that i) disrupt power relations between patients and health professionals or between different groups of health professions, ii) contribute to paradoxical outcomes and iii) result in a potentially corrosive sub-culture of pessimism about digital health.

We conclude that when implementing or evaluating digital technologies in primary care, it is wise to consider the ‘dark logic’ of the intervention (Bonell et al., 2015). Attention to issues of power relations, the potential for paradoxical outcomes, and impacts on the expectations of staff in relation to digital innovation are particularly salient in relation to the dramatic changes in primary care delivery initiated during the Covid-19 pandemic. Fostering a sense of ownership and interest in monitoring the effects that matter to the organisation will likely help counter pessimism and renew interest in deploying those digital innovations that show promise.

我们考虑可能从初级保健中使用数字健康（包括面对面咨询的替代方法、电子病历、应用程序和在线监测）的意外后果中学到什么。我们选择了一种概念性文献回顾方法，以寻求对数字健康技术（对人、关系、组织和工作方式）的意外后果的细微差别模式的更高层​​次的理解，这些技术很少仅仅是积极或消极的。该方法以现实主义审查为依据，现实主义审查承认干预措施的经验和结果在特定情况下以不同的方式起作用（或失败）。

我们提出了三个更高阶的主题，以阐明初级保健中数字健康技术意外后果的基础机制。这些主题通过案例来说明，特别关注文献中很少讨论的主题。根据 Merton (1936) 对行为者和其他人的后果的区分，这些后果是通过文化和社会结构来调节的，我们讨论了以下后果：i) 破坏患者和卫生专业人员之间或不同卫生专业人员群体之间的权力关系，ii ) 导致矛盾的结果，并且 iii) 导致对数字健康的悲观主义潜在的腐蚀性亚文化。

我们得出结论，在初级保健中实施或评估数字技术时，考虑干预的“黑暗逻辑”是明智的（Bonell 等人，2015 年）。与 Covid-19 大流行期间初级保健服务发生的巨大变化相比，对权力关系问题、矛盾结果的可能性以及对员工对数字创新期望的影响的关注尤为突出。培养主人翁意识和对监控对组织重要的影响的兴趣可能有助于消除悲观情绪，并重新激发对部署那些显示出希望的数字创新的兴趣。