Primary care randomised controlled trial of a tailored interactive website for the self-management of respiratory infections (Internet Doctor)

Paul Little, Beth Stuart, Panayiota Andreou, Lisa McDermott, Judith Joseph, Mark Mullee, Mike Moore, Sue Broomfield, Tammy Thomas, Lucy Yardley

Research output: Contribution to journalArticle (Academic Journal)peer-review

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OBJECTIVE: To assess an internet-delivered intervention providing advice to manage respiratory tract infections (RTIs).

DESIGN: Open pragmatic parallel group randomised controlled trial.

SETTING: Primary care in UK.

PARTICIPANTS: Adults (aged ≥18) registered with general practitioners, recruited by postal invitation.

INTERVENTION: Patients were randomised with computer-generated random numbers to access the intervention website (intervention) or not (control). The intervention tailored advice about the diagnosis, natural history, symptom management (particularly paracetamol/ibuprofen use) and when to seek further help.

OUTCOMES: Primary: National Health Service (NHS) contacts for those reporting RTIs from monthly online questionnaires for 20 weeks. Secondary: hospitalisations; symptom duration/severity.

RESULTS: Results 3044 participants were recruited. 852 in the intervention group and 920 in the control group reported one or more RTIs, among whom there a modest increase in NHS Direct contacts in the intervention group (intervention 44/1734 (2.5%) versus control 24/1842 (1.3%); multivariate Risk Ratio (RR) 2.53 (95% CI 1.10 to 5.82, p=0.029)). Conversely reduced contact with doctors occurred (283/1734 (16.3%) vs 368/1845 (20.0%); risk ratio 0.71, 0.53 to 0.95, p=0.019). Reduction in contacts occurred despite slightly longer illness duration (11.3 days versus 10.9 days respectively; multivariateestimate 0.48 days longer (-0.16 to 1.12, p=0.141) and more days of illness rated moderately bad or worse illness (0.53 days; 0.12 to 0.94, p=0.012). The estimate of slower symptom resolution in the intervention group was attenuated when controlling for whether individuals had used webpages which advocated ibuprofen use (length of illness 0.22 days, −0.51 to 0.95, p=0.551; moderately bad or worse symptoms 0.36 days, −0.08 to 0.80, p=0.105). There was no evidence of increased hospitalisations (risk ratio 0.13; 0.02 to 1.01; p=0.051).

CONCLUSIONS: An internet-delivered intervention for the self-management of RTIs modifies help-seeking behaviour, and does not result in more hospital admissions due to delayed help seeking. Advising the use of ibuprofen may not be helpful.


Original languageEnglish
Article numbere009769
Number of pages11
JournalBMJ Open
Issue number4
Publication statusPublished - 20 Apr 2016

Structured keywords

  • Physical and Mental Health
  • Digital Health


  • Acetaminophen/therapeutic use
  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
  • Disease Management
  • Female
  • Humans
  • Ibuprofen/therapeutic use
  • Internet
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Acceptance of Health Care
  • Primary Health Care
  • Respiratory Tract Infections/diagnosis
  • Self Care/methods
  • Self Report
  • Severity of Illness Index
  • Telemedicine/methods
  • Time Factors
  • United Kingdom

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