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

Region Skane

Status: Completed

Conditions: Influenza; Cough; Sore Throat; Common Cold; Dysuria

Treatments: Other: Physical Consultation; Other: Online Consultation

Study type: Observational

Funder types: Other

Identifiers

NCT03474887

2017/948

Details and patient eligibility

About

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.

Full description

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.

Enrollment: 4,057 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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.

Trial design

4,057 participants in 6 patient groups

DIGI-Throat

Description:

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

Treatment:

Other: Online Consultation

DIGI-Resp

Description:

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

Treatment:

Other: Online Consultation

DIGI-Dysuria

Description:

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

Treatment:

Other: Online Consultation

PHYSI-Throat+CONTROL-Throat

Description:

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.

Treatment:

Other: Physical Consultation

PHYSI-Resp+CONTROL-Resp

Description:

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.

Treatment:

Other: Physical Consultation

PHYSI-Dysuria+CONTROL-Dysuria

Description:

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.

Treatment:

Other: Physical Consultation