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

A primary care randomised controlled trial of a tailored interactive website for the self-management of respiratory infections (Internet Doctor)
A primary care randomised controlled trial of a tailored interactive website for the self-management of respiratory infections (Internet Doctor)
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.
1-9
Little, Paul
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Stuart, Beth
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Andreou, Panayiota
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McDermott, Lisa
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Joseph, Judith
edd7d342-89d2-4344-a7aa-fbcb0b1370ac
Mullee, Mark
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Moore, Mike
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Broomfield, Sue
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Thomas, Tammy
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Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Andreou, Panayiota
d0ae755f-1c7f-40d6-ba69-9632f7954f4a
McDermott, Lisa
5e895229-decd-4a30-8d08-dd9cc5b8f443
Joseph, Judith
edd7d342-89d2-4344-a7aa-fbcb0b1370ac
Mullee, Mark
fd3f91c3-5e95-4f56-8d73-260824eeb362
Moore, Mike
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Broomfield, Sue
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Thomas, Tammy
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Yardley, Lucy
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Little, Paul, Stuart, Beth, Andreou, Panayiota, McDermott, Lisa, Joseph, Judith, Mullee, Mark, Moore, Mike, Broomfield, Sue, Thomas, Tammy and Yardley, Lucy (2016) A primary care randomised controlled trial of a tailored interactive website for the self-management of respiratory infections (Internet Doctor). BMJ Open, 6 (e009769), 1-9. (doi:10.1136/bmjopen-2015-009769).

Record type: Article

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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More information

Accepted/In Press date: 18 December 2015
e-pub ahead of print date: 20 April 2016
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 391269
URI: https://eprints.soton.ac.uk/id/eprint/391269
PURE UUID: 792d74d4-2e57-4bb0-834d-501cd7973e2c
ORCID for Mike Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

Catalogue record

Date deposited: 11 Apr 2016 10:37
Last modified: 17 Jul 2019 01:06

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Contributors

Author: Paul Little
Author: Beth Stuart
Author: Panayiota Andreou
Author: Lisa McDermott
Author: Judith Joseph
Author: Mark Mullee
Author: Mike Moore ORCID iD
Author: Sue Broomfield
Author: Tammy Thomas
Author: Lucy Yardley ORCID iD

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