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

Abstract

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

Design: Open pragmatic parallel group randomised controlled trial.

Setting: Primary care in United Kingdom.

Participants: Adults (aged >=18) registered with GPs, recruited by postal invitation.

Intervention: Patients were randomised with computer-generated random numbers to access to 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: NHS contacts for those reporting RTIs from monthly on-line 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 one or more RTIs, among whom there 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%); risk ratio 0.71, 0.52 to 0.98, p=0.037). Reduction in contacts occurred despite slightly longer illness duration (11.3 days versus 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 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 0.25; 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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Identifiers

ORCID for Beth Stuart: orcid.org/0000-0001-5432-7437

ORCID for Mike Moore: orcid.org/0000-0002-5127-4509

ORCID for Lucy Yardley: orcid.org/0000-0002-3853-883X

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