Primary care randomised controlled trial of a tailored interactive website for the self-management of respiratory infections (Internet Doctor)
Little P., Stuart B., Andreou P., Mcdermott L., Joseph J., Mullee M., Moore M., Broomfield S., Thomas T., Yardley L.
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 atten uated 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.