Digital Online Consultations - Effects on Antibiotic Prescribing and Health Care Utilization in Primary Care

NCT03474887 | Completed

• 1 other identifier: 2017/948
• Study Type: observational
• Target: 4,057
• Locations: 1 country
• Sites: 1

Brief Summary

BACKGROUND/SIGNIFICANCE: With developments in mobile health and the abundance of smartphones, online consultations have emerged as a popular form of primary care in Sweden. Controversy exists regarding diagnostic accuracy, appropriate prescription of antibiotics, and effects on care-seeking patient behavior following implementation of online consultations. As empirical research is lacking, the investigators seek to evaluate online primary care consultations compared to physical consultations with regards to non-inferiority of antibiotic prescription for chief complaint of sore throat. METHODS: Medical record data is used to identify patients with a chief complaint of sore throat, cough/common cold/influenza, or dysuria after choosing online (DIGI) or physical (PHYSI) consultations. A cohort of patients with similar chief complaints prior to implementation of online consultations was used as a control group (CONTROL). Prospective data from local registries and medical records was gathered 14 days the consultation. The primary outcome was rate of antibiotic prescription after sore throat. Secondary outcomes included patient revisits (including hospital admissions), patient satisfaction, time to physician contact, registered diagnosis, and documentation or Centor Criteria and Urinary Tract Infection (UTI)-Criteria. SIGNIFICANCE: Results will shed light on whether antibiotic prescription differs significantly between digital and physical primary care consultations. Hypotheses may also be generated as to how patients seek care in light of improved availability in a tax-sponsored healthcare system.

Conditions

Sore Throat; Dysuria; Cough; Common Cold; Influenza

Keywords

Telemedicine; Remote consultation; Mobile health; Telehealth; mhealth; eVisits; eConsultation; ehealth

Outcome Measures

Primary Outcomes (1)

• Antibiotics Prescription After Sore Throat

  Proportion of patients prescribed an antibiotics (as documented in medical records) in conjunction with their initial visit with chief complaint sore throat.

  24 hours

Secondary Outcomes (11)

• Antibiotics Prescription After Cough/Common Cold/Influenza

  24 hours

• Antibiotics Prescription After Dysuria

  24 hours

• Patient Revisits

  14 days

• Type of Antibiotic Prescribed

  24 hours

• Registered Diagnosis

  24 hours

Study Arms (6)

DIGI-Throat

Patients choosing to seek primary care through an online consultation with chief complaint sore throat.

Other: Online Consultation

DIGI-Resp

Patients choosing to seek primary care through an online consultation with chief complaint cough/common cold/influenza.

Other: Online Consultation

DIGI-Dysuria

Patients choosing to seek primary care through an online consultation with chief complaint dysuria.

Other: Online Consultation

PHYSI-Throat+CONTROL-Throat

Patients choosing to seek primary care through physical consultation with chief complaint sore throat. \+ Patients seeking primary care prior to implementation of online consultations, with a chief complaint of sore throat.

Other: Physical Consultation

PHYSI-Resp+CONTROL-Resp

Patients choosing to seek primary care through physical consultation with chief complaint cough/common cold/influenza. \+ Patients seeking primary care prior to implementation of online consultations, with a chief complaint of cough/common cold/influenza.

Other: Physical Consultation

PHYSI-Dysuria+CONTROL-Dysuria

Patients choosing to seek primary care through physical consultation with chief complaint dysuria \+ Patients seeking primary care prior to implementation of online consultations, with a chief complaint of dysuria.

Other: Physical Consultation

Interventions

Physical Consultation OTHER

Regular physician consultation at the primary care clinic.

Also known as: Office Visit

PHYSI-Dysuria+CONTROL-Dysuria; PHYSI-Resp+CONTROL-Resp; PHYSI-Throat+CONTROL-Throat

Online Consultation OTHER

An online platform for communicating with a physician digitally. Patients answer a series of algorithm-based questions after specifying chief complaint, after which contact is established with a physician who can communicate through short messages. The physician can then order labs, prescribe relevant medication or book the patient for a physical consultation if need be.

Also known as: eVisit, Capio Go, Lakarbesok online

DIGI-Dysuria; DIGI-Resp; DIGI-Throat

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

The investigators seek to emulate a primary care cohort in order to make the evaluation of physical and online consultations comparable.

You may qualify if:

• Patient seeking care at primary healthcare provider (Capio in Skåne or Capio Go)
• Patient who according to medical record presents with sore throat, cough/common cold/influenza, or dysuria

You may not qualify if:

• Patient who according to medical record presents with main symptom other than sore throat, cough/common cold/influenza, or dysuria.
• Patient under the age of 18.

Sponsors & Collaborators

• Region Skane: lead
• Doctrin: collaborator
• Capio Group: collaborator
• Capio Go: collaborator
• Lund University: collaborator

Study Sites (1)

Capio Go

Malmo, Sweden

Location

Related Publications (2)

• Entezarjou A, Sjobeck M, Midlov P, Nymberg VM, Vigren L, Labaf A, Jakobsson U, Calling S. Health care utilization following "digi-physical" assessment compared to physical assessment for infectious symptoms in primary care. BMC Prim Care. 2022 Jan 12;23:4. doi: 10.1186/s12875-021-01618-2. eCollection 2022.

  PMID: 35036998 DERIVED

• Entezarjou A, Calling S, Bhattacharyya T, Milos Nymberg V, Vigren L, Labaf A, Jakobsson U, Midlov P. Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care: Observational Study. JMIR Med Inform. 2021 Mar 15;9(3):e25473. doi: 10.2196/25473.

  PMID: 33720032 DERIVED

MeSH Terms

Conditions

Pharyngitis; Dysuria; Cough; Common Cold; Influenza, Human

Interventions

Office Visits

Condition Hierarchy (Ancestors)

Respiratory Tract Infections; Infections; Pharyngeal Diseases; Stomatognathic Diseases; Respiratory Tract Diseases; Otorhinolaryngologic Diseases; Lower Urinary Tract Symptoms; Urological Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Respiration Disorders; Signs and Symptoms, Respiratory; Picornaviridae Infections; RNA Virus Infections; Virus Diseases; Orthomyxoviridae Infections

Intervention Hierarchy (Ancestors)

Professional Practice; Organization and Administration; Health Services Administration

Study Officials

• Jan Sundkvist, Professor

  CPF, Department of Clinical Sciences, Malmö

  STUDY CHAIR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 16, 2018
• First Posted: March 23, 2018
• Study Start: March 30, 2018
• Primary Completion: December 6, 2019
• Study Completion: December 20, 2021
• Last Updated: January 25, 2022

Record last verified: 2022-01

Locations

SE (1)