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

NCT ID: NCT03474887

Last Updated: 2022-01-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

4057 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-03-30

Study Completion Date

2021-12-20

Brief Summary

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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.

Detailed Description

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Due to limited recruitment of PHYSI and CONTROL patients, these cohorts will be combined into a single physical cohort to provide adequate power for analysis as per predefined required sample size.

Conditions

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Sore Throat Dysuria Cough Common Cold Influenza

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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DIGI-Throat

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

Online Consultation

Intervention Type 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.

DIGI-Resp

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

Online Consultation

Intervention Type 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.

DIGI-Dysuria

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

Online Consultation

Intervention Type 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.

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.

Physical Consultation

Intervention Type OTHER

Regular physician consultation at the primary care clinic.

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.

Physical Consultation

Intervention Type OTHER

Regular physician consultation at the primary care clinic.

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.

Physical Consultation

Intervention Type OTHER

Regular physician consultation at the primary care clinic.

Interventions

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Physical Consultation

Regular physician consultation at the primary care clinic.

Intervention Type OTHER

Online Consultation

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.

Intervention Type OTHER

Other Intervention Names

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Office Visit eVisit Capio Go Lakarbesok online

Eligibility Criteria

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Inclusion Criteria

* 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

Exclusion Criteria

* 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.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Doctrin

UNKNOWN

Sponsor Role collaborator

Capio Group

OTHER

Sponsor Role collaborator

Capio Go

UNKNOWN

Sponsor Role collaborator

Lund University

OTHER

Sponsor Role collaborator

Region Skane

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jan Sundkvist, Professor

Role: STUDY_CHAIR

CPF, Department of Clinical Sciences, Malmö

Locations

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Capio Go

Malmo, , Sweden

Site Status

Countries

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Sweden

References

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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.

Reference Type DERIVED
PMID: 35036998 (View on PubMed)

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.

Reference Type DERIVED
PMID: 33720032 (View on PubMed)

Other Identifiers

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2017/948

Identifier Type: -

Identifier Source: org_study_id

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