Authors: Peters Y, Smits M, Giesen P.
More than half of the requests for assistance at the huisartsenpost (HAP) are not urgent from a medical perspective, and some of them could be helped with self-care advice. Unnecessary healthcare consumption causes overburdening of the healthcare system. The vision for healthcare should be: “self-care where possible, general practitioner care when necessary, and specialist care when it is really necessary.” The app “Moet ik naar de dokter?” was developed on the initiative of the HAP in Apeldoorn. This is a self-triage tool that allows people to assess whether and when it is necessary to contact a doctor. In most cases, self-care advice is also given. This study examines the content validity of the app: is the medical content of the app correct?
- Are the correct questions asked?
- Is the correct urgency/care intervention determined? (contact advice or not (general practitioner/doctor))
- Are the self-care advice and answers to frequently asked questions (F.A.Q.) correct?
Medical expert assessment of the content of the app “Moet ik naar de dokter?”, version October 31, 2013.
The complaints (N=141), advice (N=207), and frequently asked questions (F.A.Q.) (N=12) were independently assessed by one triage nurse and one general practitioner (from a group of two general practitioners and two triage nurses). Pre-designed assessment forms were used. If their answers to the key questions did not match, they were discussed during a consensus meeting.
According to the assessors, the correct questions were not asked in 44.9% of the presenting complaints to determine the correct urgency: one or more of the so-called “red questions” from the NHG Triagewijzer were missing in 4.9% of the complaints. In 33.0% of the complaints, the order of the questions was illogical, and in 14.4%, the questions were possibly incomprehensible to the patient. For 84.3% of the complaints, a different urgency was given for at least one of the questions than the assessors had expected: in 54.8% of the complaints, the desired urgency according to the assessor was lower than the given urgency (overestimation of urgency). In 1.4% of the complaints, a U5 (and therefore only self-care advice) was given, while it should have been a U4 (contact advice: to the general practitioner). In 2.1% of the complaints, a U4 was given when it should have been a U5. In 26.1% of the complaints, a patient with a U4 urgency should not be advised to wait until their own general practitioner is available outside office hours (delayed contact advice). In 4.3% of the complaints, the user receives a different self-care advice than the assessors expected based on the complaint and the answers to the previous questions. 14.0% of the advice given did not match what the assessors would advise themselves. The assessors found 15.3% of the advice (partly) incomprehensible to the patient and 13.5% (partly) unfeasible. 28.0% of the advice was seen as (partly) incomplete and 4.9% as (partly) redundant. 34.0% of the U5 advice was not or only partly seen as reassuring. App “Moet ik naar de dokter?” 33.3% of the answers in the F.A.Q. would not be given by the evaluators themselves. The evaluators found 8.3% of the answers in the F.A.Q. (partially) incomprehensible for the patient, 17.4% (partially) impractical, 33.4% (partially) incomplete, and 4.3% partially unnecessary.
Based on the results, it can be concluded that the content validity of the app “Moet ik naar de dokter?” needs improvement, especially regarding the specific urgencies that are given. Considering the practical use of the urgency classification (U1-U4 is generally equated with contact advice), it can be said that the app is safe and does not stimulate overconsumption, after adjustments to a limited number of complaints (adding “red questions” for certain complaints, correcting U4 versus U5 deviations and/or delaying contact advice). In addition, the researchers advise a detailed revision of the content of the app based on the specific information obtained from the study. When adjustments are made to the app, it is recommended to have medical experts review them.