Limited evidence of benefits of patient operated intelligent primary care triage tools: findings of a literature review

Gottliebsen, Kristian; Petersson, Göran

doi:10.1136/bmjhci-2019-100114

Cited by 55 publications

(83 citation statements)

References 21 publications

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“…The 2 most recent non-industry-funded audit studies using this methodology rated SC triage capability as unreliable, with an average of only 49% and 58% of appraisals deemed correct [10,11]. In line with these findings, a 2020 literature review concluded that most investigated SCs offered limited benefits [12].…”

Section: Evidence On Scsmentioning

confidence: 93%

Benchmarking Triage Capability of Symptom Checkers Against That of Medical Laypersons: Survey Study

Schmieding¹,

Mörgeli²,

Schmieding³

et al. 2021

J Med Internet Res

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Background Symptom checkers (SCs) are tools developed to provide clinical decision support to laypersons. Apart from suggesting probable diagnoses, they commonly advise when users should seek care (triage advice). SCs have become increasingly popular despite prior studies rating their performance as mediocre. To date, it is unclear whether SCs can triage better than those who might choose to use them. Objective This study aims to compare triage accuracy between SCs and their potential users (ie, laypersons). Methods On Amazon Mechanical Turk, we recruited 91 adults from the United States who had no professional medical background. In a web-based survey, the participants evaluated 45 fictitious clinical case vignettes. Data for 15 SCs that had processed the same vignettes were obtained from a previous study. As main outcome measures, we assessed the accuracy of the triage assessments made by participants and SCs for each of the three triage levels (ie, emergency care, nonemergency care, self-care) and overall, the proportion of participants outperforming each SC in terms of accuracy, and the risk aversion of participants and SCs by comparing the proportion of cases that were overtriaged. Results The mean overall triage accuracy was similar for participants (60.9%, SD 6.8%; 95% CI 59.5%-62.3%) and SCs (58%, SD 12.8%). Most participants outperformed all but 5 SCs. On average, SCs more reliably detected emergencies (80.6%, SD 17.9%) than laypersons did (67.5%, SD 16.4%; 95% CI 64.1%-70.8%). Although both SCs and participants struggled with cases requiring self-care (the least urgent triage category), SCs more often wrongly classified these cases as emergencies (43/174, 24.7%) compared with laypersons (56/1365, 4.10%). Conclusions Most SCs had no greater triage capability than an average layperson, although the triage accuracy of the five best SCs was superior to the accuracy of most participants. SCs might improve early detection of emergencies but might also needlessly increase resource utilization in health care. Laypersons sometimes require support in deciding when to rely on self-care but it is in that very situation where SCs perform the worst. Further research is needed to determine how to best combine the strengths of humans and SCs.

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Section: Evidence On Scsmentioning

confidence: 93%

Benchmarking Triage Capability of Symptom Checkers Against That of Medical Laypersons: Survey Study

Schmieding¹,

Mörgeli²,

Schmieding³

et al. 2021

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…The asynchronous chat function can be experienced as more flexible in some health related settings, allowing contact to more smoothly fit into daily life [53], simultaneously providing an opportunity collecting medical information via predefined questionnaires. Some even suggest AI based triage tools could relieve healthcare personal with remaining quality, even though the validity of this claim can be questioned so far [54].…”

Section: Current Trends With Patient-centric Servicesmentioning

confidence: 99%

The effects of automation of a patient-centric service in primary care on the work engagement and exhaustion of nurses

2020

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Digitalising patient-centric services to address society’s challenges with an ageing population and healthcare provision is by many seen as important. Studying the effects of the digitalisation on the work engagement of the users of the new systems is vital in this context, especially since previous research has established that the work engagement at work in healthcare is problematic. Work engagement is defined as a positive, fulfilling, affective-motivational state of work related well being, as is closely connected to the experience of resources and demands in the work context. These resources can be for example digital support, experienced demands or empowerment whereas exhaustion is connected to work demand in a workplace. This study contributes to knowledge about the effects of digitalisation on work engagement and exhaustion in the context of patient-centred services and eHealth. Contextual interviews were conducted on site for 5 h with nurses using a new chat function and using telephone for medical advice to patients. Additionally, semi-structured interviews were conducted with all the nurses participating in this digitalisation project to gather more insights into their work engagement in the two work situations. Results were analysed in different themes of areas affected by the digitalisation in the two overarching themes: job demands and job resources. The results show that the change to a chat function when communicating with advice seekers had connection to work engagement in several ways. The nurses experienced less time pressure and emotional pressure, but also a loss of job control and feedback from colleagues working from home.

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“…[2,3] Governments have also incorporated SCs to alleviate the increasing burden that is placed upon both primary care services and emergency services, particularly in light of the COVID-19 pandemic. [4][5][6] It has been previously estimated that 12% of Emergency Department (ED) attendances would be more appropriately managed by other services. [7,8] Hence, SCs can reduce the financial and resource burden of the NHS, and redirect them towards truly in need.…”

Section: Introductionmentioning

confidence: 99%

The diagnostic and triage accuracy of digital and online symptom checker tools: a systematic review

Wallace

Chan

Chidambaram

et al. 2021

Preprint

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Objective To evaluate the accuracy of digital and online symptom checkers in providing diagnoses and appropriate triage advice. Design Systematic review. Data sources Medline and Web of Science were searched up to 15 February 2021. Eligibility criteria for study selection Prospective and retrospective cohort, vignette, or audit studies that utilised an online or application-based service designed to input symptoms and biodata in order to generate diagnoses, health advice and direct patients to appropriate services were included. Main outcome measures The primary outcomes were (1) the accuracy of symptom checkers for providing the correct diagnosis and (2) the accuracy of subsequent triage advice given. Data extraction and synthesis Data extraction and quality assessment (using the QUADAS-2 tool) were performed by two independent reviewers. Owing to heterogeneity of the studies, meta-analysis was not possible. A narrative synthesis of the included studies and pre-specified outcomes was completed. Results Of the 177 studies retrieved, nine cohort studies and one cross-sectional study met the inclusion criteria. Symptom checkers evaluated a variety of medical conditions including ophthalmological conditions, inflammatory arthritides and HIV. 50% of the studies recruited real patients, while the remainder used simulated cases. The diagnostic accuracy of the primary diagnosis was low (range: 19% to 36%) and varied between individual symptom checkers, despite consistent symptom data input. Triage accuracy (range: 48.8% to 90.1%) was typically higher than diagnostic accuracy. Of note, one study found that 78.6% of emergency ophthalmic cases were under-triaged. Conclusions The diagnostic and triage accuracy of symptom checkers are variable and of low accuracy. Given the increasing push towards population-wide digital health technology adoption, reliance upon symptom checkers in lieu of traditional assessment models, poses the potential for clinical risk. Further primary studies, utilising improved study reporting, core outcome sets and subgroup analyses, are warranted to demonstrate equitable and non-inferior performance of these technologies to that of current best practice. PROSPERO registration number CRD42021271022.

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Limited evidence of benefits of patient operated intelligent primary care triage tools: findings of a literature review

Cited by 55 publications

References 21 publications

Benchmarking Triage Capability of Symptom Checkers Against That of Medical Laypersons: Survey Study

Benchmarking Triage Capability of Symptom Checkers Against That of Medical Laypersons: Survey Study

The effects of automation of a patient-centric service in primary care on the work engagement and exhaustion of nurses

The diagnostic and triage accuracy of digital and online symptom checker tools: a systematic review

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