Digital triage to discriminate medical complaints for which a general practitioner (GP) should be consulted from complaints for which a self-care advice can be given.

Authors:

Stef Verlinden, Vivici BV, Leiden, the Netherlands
Lisette van Gemert-Pijnen, University of Twente

Introduction:

On average every Dutch visits their GP 1,4 times a year for a new medical complaint. Among the most frequently presented complaints are cough, nasal congestion, throat complaints, low back pain, headache, neck/shoulder complaints and diarrhea. In more than 80% a self-care advice is given.
To support the GP’s the Dutch College of General Practitioners (NHG) has developed professional standards for telephone triage. Doctor assistants use these standards to determine whether a patient can come to visit the GP.

Objective:

To examine whether digital triage based on NHG standards can empower patients and promote self-management of self-limiting diseases.

Methods:

A symptom driven expert system was developed. Twenty-five ‘entry’ complaints were selected based on the following criteria: high frequency, no physical contact required to assess medical situation and the possibility to rule out emergency situations. The system was certified based on ISO 9000:2000 standards by an independent certification institute (TNO-QMIC).
Through a secure website the patient can enter the expert system by selecting the main complaint. Each complaint leads to a specific triage module. Information required to asses the specific situation is gathered through a dynamic questionnaire which is can vary on gender, age and the answer on the previous question. On top of that patients were asked to answer an additional 4-8 question about the service. Upon completion the expert system assesses the urgency of the current situation and provides an advice.
Those advices vary from ‘contact a doctor immediately’ to a self-care advice.

Results:

In a pilot study almost 2000 individuals used digital triage to assess their everyday medical complaints. 65.1% of the patients who started a digital consult completed it. Of them 52% answered the additional questions. Asked about their reason, 75,9% answered that they wanted to find out what to do with the complaint they had. Of those 81,5% originally planned to visit their GP for that complaint.
In 17,4% a self-care advice was provided. 79% of the patients who received a self-care advice indicated that they would follow the self-care advice first and postpone the planned visit to the GP.
89,1% rated the advice and information they received as good or better. 62,3% rated it as great or outstanding.
A follow up study in which the long-term effects are studied is on its way.

Discussion:

The system developed was able to perform automated digital triage for a specific group of everyday medical complaints. The high ratings suggest that patients are empowered by digital triage. The fact that a vast majority of the patients who received a self-care advice postponed their planned visit to their GP seems to support the idea that digital triage can be used to promote self-management of self-limiting diseases.
Further studies have to be conducted to value the potential role of digital triage in the primary health care process.

Oral presentation @ MedNet2006 Toronto