Authors of this interesting study have developed a theoretically informed internet-delivered
intervention to manage respiratory tract infections among adults (‘The Internet Doctor’)
that they have shown in a small
exploratory trial results in higher levels of satisfaction, enablement
and understanding of
illness.
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
3044 participants were recruited. 852 in the intervention group and 920
in the control group reported 1 or more RTIs, among
whom there was a modest increase in
NHS direct contacts in the intervention group (intervention 37/1574
(2.4%) versus control
20/1661 (1.2%); multivariate risk
ratio (RR) 2.25 (95% CI 1.00 to 5.07, p=0.048)). Conversely, reduced
contact with doctors
occurred (239/1574 (15.2%) vs
304/1664 (18.3%); RR 0.71, 0.52 to 0.98, p=0.037). Reduction in contacts
occurred despite slightly
longer illness duration (11.3 days
vs 10.7 days, respectively; multivariate estimate 0.60 days longer
(−0.15 to 1.36, p=0.118)
and more days of illness rated
moderately bad or worse illness (0.52 days; 0.06 to 0.97, p=0.026). The
estimate of slower
symptom resolution in the
intervention group was attenuated when controlling for whether
individuals had used web pages 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 0.25; 0.05 to
1.12; p=0.069).
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.
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