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.
- Physical and Mental Health
- Digital Health
- Acetaminophen/therapeutic use
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Disease Management
- Ibuprofen/therapeutic use
- Logistic Models
- 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
- Time Factors
- United Kingdom