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

Abstract

ObjectiveTo assess an internet-delivered intervention providing advice to manage respiratory tract infections (RTIs).DesignOpen pragmatic parallel group randomised controlled trial.SettingPrimary care in UK.ParticipantsAdults (aged ≥18) registered with general practitioners, recruited by postal invitation.InterventionPatients 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.OutcomesPrimary: National Health Service (NHS) contacts for those reporting RTIs from monthly online questionnaires for 20 weeks. Secondary: hospitalisations; symptom duration/severity.Results3044 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).ConclusionsAn 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 numberISRCTN91518452.

The anti-viral facet of anti-rheumatic drugs: Lessons from COVID-19

“…In patients with acute respiratory infection, NSAIDs have been widely used and evidence suggests that in these circumstances NSAIDs are associated with an increased risk of stroke and myocardial infarction [67][68][69]. Moreover, large randomized trials support that NSAIDs may cause more prolonged illness or complications when taken during respiratory tract infections [70,71]. Patients with COVID-19 have a higher risk of hospitalization, critical disease and mortality correlated with age and presence of comorbidities, particularly hypertension.…”

Respiratory tract infection-related healthcare utilisation in children with Down’s syndrome

“…An additional proportion of medically attended RTIs in both children with DS and controls will be missed, as RTIs are seen not only by GPs but also at other ambulatory care centres (i.e. urgent care centres, outof-hours GP) and A&E. Finally, and importantly, research has noted that most RTIs do not lead to a GP consultation [18]. There is little qualitative evidence on healthcare seeking behaviour in families of children with DS, and whether this varies from other patient groups.…”

Digital interventions for parents of acutely ill children and their treatment-seeking behaviour: a systematic review

“…A previous review investigated the effects of paper-based interventions, demonstrating that parental help seeking behaviour can be modified (18). Online interventions for acute illness have been shown to modify health-seeking behaviour without increasing hospital admissions in adults (19). There is huge scope to empower parents to provide home care for children who have frequent self-limiting acute illnesses.…”

“…Our findings highlight the need for rigorous evaluation of digital interventions, and the need to develop interventions in collaboration with their intended target populations, for example through the person-based approach (24). There are many examples of where the person based approach has resulted in the development of cost-effective digital interventions, such as 'Internet Doctor", an interactive website for the self-management of respiratory infections which was shown to reduce contact with doctors without increasing hospital admissions (19). Self-care advice on mHealth apps (for which acceptability and intention to follow was modest in this review) also needs to be optimised for the target population, and further links given to endorsed websites and educational resources (16) (35).…”