Authors: Smits M, Giesen P
“Moet ik naar de dokter?” (MINDD) is a self-triage tool that allows people to assess whether and when it is necessary to contact the huisartsenpost. One goal of MINDD is to promote self-care and reduce medically unnecessary healthcare consumption. Currently, more than half of all huisartsenposten in the Netherlands offer digital self-triage with MINDD on their website.
To gain more insight into the use and effects of digital self-triage with MINDD at the huisartsenpost.
Quasi-experimental study at 11 huisartsenposten in the Netherlands. A block design was applied for six weeks, alternating weeks where MINDD was offered on the huisartsenpost website (intervention group) and weeks where it was not offered (control group). The study population consisted of patients who contacted one of the participating huisartsenposten and/or used MINDD on the website of the respective huisartsenpost. Anonymous data from the MINDD log system and the patient registration system of the huisartsenposten (HIS) were used for the study. Descriptive analyses were used to map the frequency of digital self-triage use and the characteristics of the users in the intervention group. In addition, the numbers of telephone consultations, physical consultations, and visits during the intervention period were compared with the control period. Multiple linear regression analyses were performed to investigate the average duration of telephone triage when digital self-triage was or was not performed beforehand. For patients who contacted the huisartsenpost after self-triage, the extent to which the self-triage advice matched the assistance provided by the triage nurse was examined. Multiple logistic regression analysis was used to investigate the characteristics of patients with false positive and false negative advice.
A total of 7,963 self-triage assessments were performed by 6,349 unique users. The number of self-triage users was 2.4 per 100 inhabitants per year within the total working area of the participating huisartsenposten. This number varied considerably between the huisartsenposten (0.6 to 5.6). MINDD was used for patients of all ages, slightly more often by women, and especially outside office hours. The most common complaints were allergic reaction/insect bite, abdominal pain, and coughing. In 79% of the self-triage assessments, the advice was to call the huisartsenpost or 112. In 19% of the self-triage assessments, the patient contacted the huisartsenpost. If the self-triage advice was not to call, the patient followed this advice in 92% of cases. The average duration of self-triage was 50 seconds. The time between self-triage and contact with the huisartsenpost (including telephone waiting time) was an average of 25 minutes. There was no difference in the total number of contacts at the huisartsenposten in weeks with and without MINDD. However, at the huisartsenposten where MINDD was used the most, a decrease in (mainly telephone) contacts was observed. It did not matter whether the patient had performed online self-triage before or not for the duration of telephone triage. Among the patients who contacted the huisartsenpost after self-triage, 46% of the self-triage advice was false positive, and 3% was false negative. The chance of a false positive result was higher for self-triage symptoms such as headache, foot injury/accident, skin problems, allergic reaction/insect bite, and back pain. However, for shortness of breath and chest pain, there was a lower chance of a false positive result. The likelihood of a false positive result was greater at night than during the day (on weekends). There were no predictive characteristics for a false negative advice.
The study provided insight into the self-triage user profile. In 19% of the self-triage cases, the patient contacted the huisartsenpost. When the self-triage advice was not to call, the patient followed it in 92% of cases. This could mean that a group of patients who would have otherwise contacted the huisartsenpost are no longer doing so because of MINDD. Currently, there is no visible effect of MINDD on the total number of contacts and costs at the huisartsenposten, nor on the duration of telephone triage. However, it is possible to reduce the number of contacts and costs using the self-triage instrument, as there was a decrease observed at the huisartsenposten where MINDD was used the most. It is expected that the duration of telephone triage will also decrease, as the triage nurse gains insight into the self-triage carried out beforehand, as is now the case in some huisartsenposten. Repetition of the study during other periods of the year is recommended, with follow-up of the actions taken by the patient after self-triage, so that the sensitivity and specificity of MINDD can be determined.