Computer Generated Self-Care Advice via Web-Based Triage of Complaints in Primary Care

Abstract

− − − −Computer generated self-care advice systems are used in health care to support self-management and to respond to an increasing demand for care. Web-based triage is an innovative system aimed at empowering patients and saving costs while maintaining the same or better quality of care. Such systems consist of a symptom driven questionnaire for minor ailments based on the criteria: high frequency, no physical contact required to assess medical situation, and the possibility to rule out emergencies. We evaluated the feasibility of such a system for self-care. A retrospective analysis was carried out among 6538 patients by investigating the frequencies of complaints that have been entered to the system and the frequencies of the kinds of generated advice; online surveys (n=192) based on behavioral theories were held to determine factors influencing compliance with generated self-care advice. Web-based triage can promote selfmanagement for minor ailments, especially for patients who have a positive attitude towards computer-generated advice. This positive attitude leads to intentions to follow up the advice and to actual follow up. To reduce unnecessary doctors' visits and to lower health care costs the system has to be brought more in to line with users' needs because the systems are more medical driven than user-centered.

Evaluation of a Web-based Intervention Providing Tailored Advice for Self-management of Minor Respiratory Symptoms: Exploratory Randomized Controlled Trial

“…Only a minority of people were advised to contact health services, a much smaller proportion than in previous studies of triage for minor symptoms [ 20 , 36 ]. The low rate of advice to use health services could be due to our sample of young, healthy people, who were consulting mainly for minor symptoms, but could also reflect a triage system that had a slightly higher severity threshold for recommending contacting health services.…”

Health literacy interventions for reducing the use of primary and emergency services for minor health problems: a systematic review

“…114 Behaviour, enablement and intentions The mixed findings on satisfaction for the app and website were also reflected in respondents' intentions: satisfaction with the app or website was highest for those respondents who received advice commensurate with their prespecified intentions. 113,140 Two studies that reported a positive change in behaviour and intentions to consult also reported positive effects on either satisfaction 53 or satisfaction and confidence. 98…”

“…[108][109][110][111][112] Many such interventions reported the corollary rationale of reducing unnecessary primary or emergency care use as a result of improved knowledge. 53,75,76,103,113,114 Unlike the primary and emergency care interventions, the majority of community and workplace-based interventions had the specific aim of improving self-care and participants' knowledge, both of illnesses (including some specific minor problems such as childhood fever or cough) [79][80][81][82][115][116][117][118][119][120][121] and when to access what service. 122,123 A smaller number of such studies explicitly reported that the aim of an intervention was to reduce use of primary care, 124 emergency care 125,126 or health services generally.…”

“…Nine studies reported self-triage interventions: most of them were digital self-triage interventions, 53,84,98,104,113,114,140 and two older studies report a paper-based symptom-scoring system akin to self-triage. 132,133 They are presented in Table 14 in alphabetical order within these digital and paper groups.…”

“…The majority of physicians targeted the pamphlet only to low-acuity visits, with some also using the pamphlet for medium-acuity visits as a way to reinforce that those caregivers had made the correct choice in coming to the PED Ladley 2018 90 Text messages 12 months Self-report High levels of satisfaction and engagement at the 12-month survey in the intervention group: 91% (75/79 who completed the survey) felt more comfortable making decisions about when to take their baby to the ED Self-report l 80% believed that the training intervention helped them avoid an ED or after-hours visit, similarly for the ear drops l (+) Satisfaction: using a scoring system from -10 to 10, parents at the 15-month WCV strongly endorsed this intervention, showing support for both aspects of the intervention (nurse teaching and access to prescription) l (+) Satisfaction: support for this intervention remained high for those seen at the 24-month WCV, even for families who had not experienced an episode of ear pain after the nursing intervention l (+) Intentions: when surveyed at the 24-month WCV, 42.0% of parents indicated that their children had in fact experienced ear pain since the 15-month WCV. More than 80% of this subgroup believed that the nursing education helped them avoid an ED or after-hours visit: 113 Web-based triage 54 weeks Self-report l 15% of patients were given self-care advice, so authors considered it to be a very cautious intervention l Intentions: patients used the triage system to gather information about their complaint (n = 72, 49%), more than for deciding whether or not a doctor needed to be contacted (n = 38, 26%) l Preceding the triage consultation, nearly half of patients (n = 73, 49%) had the intention to visit a GP for their complaint.…”