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Primary care randomised controlled trial of a tailored interactive website for the self-management of respiratory infections (Internet Doctor)
  1. Paul Little1,
  2. Beth Stuart1,
  3. Panayiota Andreou1,
  4. Lisa McDermott1,
  5. Judith Joseph2,
  6. Mark Mullee3,
  7. Mike Moore1,
  8. Sue Broomfield1,
  9. Tammy Thomas1,
  10. Lucy Yardley2
  1. 1Primary Care Group, Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
  2. 2Centre for the Applications of Health Psychology, University of Southampton, Southampton, UK
  3. 3Research Design Service South Central, Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
  1. Correspondence to Dr Paul Little; P.Little{at}soton.ac.uk

Abstract

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.

Trial registration number ISRCTN91518452.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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