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

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Abstract

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.

TRIAL REGISTRATION NUMBER: ISRCTN91518452.

Original languageEnglish
Article numbere009769
Number of pages11
JournalBMJ Open
Volume6
Issue number4
DOIs
Publication statusPublished - 20 Apr 2016

Structured keywords

  • Physical and Mental Health
  • Digital Health

Keywords

  • 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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    This is the final published version of the article (version of record). It first appeared online via BMJ at https://bmjopen.bmj.com/content/6/4/e009769 . Please refer to any applicable terms of use of the publisher.

    Final published version, 986 KBLicence: CC BY

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