智能手机应用程序进行急性初级保健的自我分诊：实用、安全且高效吗？
Self-triage for acute primary care via a smartphone application: Practical, safe and efficient?
机构信息
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
出版信息
PLoS One. 2018 Jun 26;13(6):e0199284. doi: 10.1371/journal.pone.0199284. eCollection 2018.
BACKGROUND
Since the start of out-of-hours (OOH) primary care clinics, the number of patient consultations has been increasing. Triage plays an important role in patient selection for a consultation, and in providing reassurance and self-management advice.
OBJECTIVE
We aimed to investigate whether the smartphone application "Should I see a doctor?" (in Dutch:"moet ik naar de dokter?") could guide patients in appropriate consultation at OOH clinics by focusing on four topics: 1) app usage, 2) user satisfaction, 3) whether the app provides the correct advice, and 4) whether users intend to follow the advice.
DESIGN AND SETTING
A prospective, cross-sectional study amongst app users in a routine primary care setting.
METHODS
The app is a self-triage tool for acute primary care. A built-in questionnaire asked users about the app's clarity, their satisfaction and whether they intended to follow the app's advice (n = 4456). A convenience sample of users was phoned by a triage nurse (reference standard) to evaluate whether the app's advice corresponded with the outcome of the triage call (n = 126). Suggestions of phoned participants were listed.
RESULTS
The app was used by patients of all ages, also by parents for their children, and mostly for abdominal pain, skin disorders and cough. 58% of users received the advice to contact the clinic, 34% a self-care advice and 8% to wait-and-see. 65% of users intended to follow the app's advice. The app was rated as 'neutral' to 'very clear' by 87%, and 89% were 'neutral' to 'very satisfied'. In 81% of participants the app's advice corresponded to the triage call outcome, with sensitivity, specificity, positive- and negative predictive values of 84%, 74%, 88% and 67%, respectively.
CONCLUSION
The app "Should I see a doctor?" could be a valuable tool to guide patients in contacting the OOH primary care clinic for acute care. To further improve the app's safety and efficiency, triaging multiple symptoms should be facilitated, and more information should be provided to patients receiving a wait-and-see advice.
背景
自非办公时间（OOH）初级保健诊所开设以来，患者就诊人数不断增加。分诊在为患者选择就诊时起着重要作用，并能提供安慰和自我管理建议。
目的
我们旨在通过关注四个主题，研究智能手机应用程序“我是否应该去看医生？”（荷兰语：“moet ik naar de dokter？”）是否可以通过指导 OOH 诊所的患者进行适当的就诊：1）应用程序使用情况，2）用户满意度，3）应用程序是否提供正确的建议，以及 4）用户是否打算遵循该建议。
设计和设置
在常规初级保健环境中对应用程序使用者进行前瞻性、横断面研究。
方法
该应用程序是一种用于急性初级保健的自我分诊工具。内置的问卷询问用户应用程序的清晰度、他们的满意度以及他们是否打算遵循应用程序的建议（n = 4456）。由分诊护士对应用程序使用者进行电话随访（参考标准），以评估应用程序的建议是否与分诊电话的结果相符（n = 126）。列出了电话随访参与者的建议。
结果
该应用程序被所有年龄段的患者使用，也被父母用于其子女，主要用于腹痛、皮肤疾病和咳嗽。58%的用户收到了联系诊所的建议，34%收到了自我护理建议，8%收到了等待观察的建议。65%的用户打算遵循应用程序的建议。87%的用户将应用程序评为“中立”到“非常清楚”，89%的用户评为“中立”到“非常满意”。在 81%的参与者中，应用程序的建议与分诊电话结果相符，其灵敏度、特异性、阳性预测值和阴性预测值分别为 84%、74%、88%和 67%。
结论
应用程序“我是否应该去看医生？”可以成为指导患者在急性护理期间联系 OOH 初级保健诊所的有价值的工具。为了进一步提高应用程序的安全性和效率，应方便对多种症状进行分诊，并向接受等待观察建议的患者提供更多信息。
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