Digital self-triage: how compliant is the patient?

Anthony Pairon, Veronique Verhoeven, Hilde Philips

Keywords: triage, symptom checker, self-triage, digital, e-health, m-health, care seeking behaviour, compliance

Background:

Online symptom checkers and digital triage tools are part of a current effort to better assist patients in their healthcare seeking behavior. Compliance in particular requires a more solid evidence-based approach, with limited evidence currently focusing on intention to comply, rather than quantifying the direct impact on patients’ decision-making.

Research questions:

RQ1: How compliant are people with the advice given by a digital self-triage tool?
RQ1.1: How do patient, urgency, disease, and triage characteristics influence compliance?
RQ2: To what degree do intention to comply and compliance correlate?

Method:

A prospective longitudinal observational study was designed as a proof of concept in which an online triage tool was integrated into a GPC website. Routine registration data of the triage system was linked to a second dataset from ICAREdata, containing anonymous patient data from unplannable care systems. Algorithmic data-matching visualised the patient flow through the healthcare system.(n=398)
A structured questionnaire gaged the patient's intention pre- and post-advice, the impact of triage on care seeking behaviour, and underlying motivational drivers.(n=99) These results were matched to compare intention to subsequent action.

Results:

Overall, 67.3% complied to the advice given, which increased to 77% for those receiving a non-urgent triage advice (U5). Compliance was associated to utilisation in the weekend v. weeknight (OR 2.9 95% CI 1.3–3.9, p<0.002). 97% of survey respondents believed they required a doctor prior to triage. After utilization, 88.9% indicated they intended to comply, yet in 26.8% of cases observed, behaviour differed from their stated intention.

Conclusions:

Patient adherence to triage advice is generally high for the studied tool and in line with current evidence. There is considerable discrepancy between patient behavior and their declared intention, warranting caution when using the latter as a proximal outcome. Future research on compliance should be of relevant scale and scope and be performed within the tools’ intended setting.

Points for discussion:

Care seeking behaviour in Out-Of-Hours settings.

Patient compliance with digital medical tools.

Compliance v. intention to comply.

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