Schmieding Malte L, Kopka Marvin, Bolanaki Myrto, Napierala Hendrik, Altendorf Maria B, Kuschick Doreen, Piper Sophie K, Scatturin Lennart, Schmidt Konrad, Schorr Claudia, Thissen Alica, Wäscher Cornelia, Heintze Christoph, Möckel Martin, Balzer Felix, Slagman Anna
Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Division of Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany.
J Med Internet Res. 2025 Apr 2;27:e64028. doi: 10.2196/64028.
Symptom checker apps (SCAs) are layperson-facing tools that advise on whether and where to seek care, or possible diagnoses. Previous research has primarily focused on evaluating the accuracy, safety, and usability of their recommendations. However, studies examining SCAs' impact on clinical care, including the patient-physician interaction and satisfaction with care, remain scarce.
This study aims to evaluate the effects of an SCA on satisfaction with the patient-physician interaction in acute care settings. Additionally, we examined its influence on patients' anxiety and trust in the treating physician.
This parallel-group, randomized controlled trial was conducted at 2 emergency departments of an academic medical center and an emergency practice in Berlin, Germany. Low-acuity patients seeking care at these sites were randomly assigned to either self-assess their health complaints using a widely available commercial SCA (Ada Health) before their first encounter with the treating physician or receive usual care. The primary endpoint was patients' satisfaction with the patient-physician interaction, measured by the Patient Satisfaction Questionnaire (PSQ). The secondary outcomes were patients' satisfaction with care, their anxiety levels, and physicians' satisfaction with the patient-physician interaction. We used linear mixed models to assess the statistical significance of primary and secondary outcomes. Exploratory descriptive analyses examined patients' and physicians' perceptions of the SCA's utility and the frequency of patients questioning their physician's authority.
Between April 11, 2022, and January 25, 2023, we approached 665 patients. A total of 363 patients were included in the intention-to-treat analysis of the primary outcome (intervention: n=173, control: n=190). PSQ scores in the intervention group were similar to those in the control group (mean 78.5, SD 20.0 vs mean 80.8, SD 19.6; estimated difference -2.4, 95% CI -6.3 to 1.1, P=.24). Secondary outcomes, including patients' and physicians' satisfaction with care and patient anxiety, showed no significant group differences (all P>.05). Patients in the intervention group were more likely to report that the SCA had a beneficial (66/164, 40.2%) rather than a detrimental (3/164, 1.8%) impact on the patient-physician interaction, with most reporting no effect (95/164, 57.9%). Similar patterns were observed regarding the SCA's perceived effect on care. In both groups, physicians rarely reported that their authority had been questioned by a patient (intervention: 2/188, 1.1%; control: 4/184, 2.2%). While physicians more often found the SCA helpful rather than unhelpful, the majority indicated it was neither helpful nor unhelpful for the encounter.
We found no evidence that the SCA improved satisfaction with the patient-physician interaction or care in an acute care setting. By contrast, both patients and their treating physicians predominantly described the SCA's impact as beneficial. Our study did not identify negative effects of SCA use commonly reported in the literature, such as increased anxiety or diminished trust in health care professionals.
German Clinical Trial Register DRKS00028598; https://drks.de/search/en/trial/DRKS00028598/entails.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-022-06688-w.
症状检查应用程序（SCA）是面向非专业人士的工具，用于就是否就医、前往何处就医或可能的诊断提供建议。以往的研究主要集中在评估其建议的准确性、安全性和可用性。然而，研究SCA对临床护理的影响，包括患者与医生的互动以及对护理的满意度的研究仍然很少。
本研究旨在评估SCA对急性护理环境中患者与医生互动满意度的影响。此外，我们还研究了其对患者焦虑和对主治医生信任的影响。
这项平行组随机对照试验在德国柏林一家学术医疗中心的2个急诊科和一家急诊诊所进行。在这些地点寻求护理的低急症患者被随机分配，要么在首次与主治医生接触之前使用一款广泛使用的商业SCA（Ada Health）自我评估其健康问题，要么接受常规护理。主要终点是患者对患者与医生互动的满意度，通过患者满意度问卷（PSQ）进行测量。次要结果包括患者对护理的满意度、焦虑水平以及医生对患者与医生互动的满意度。我们使用线性混合模型评估主要和次要结果的统计学意义。探索性描述性分析考察了患者和医生对SCA效用的看法以及患者质疑医生权威的频率。
在2022年4月11日至2023年1月25日期间，我们接触了665名患者。共有363名患者纳入主要结果的意向性分析（干预组：n = 173，对照组：n = 190）。干预组的PSQ评分与对照组相似（均值78.5，标准差20.0 vs均值80.8，标准差19.6；估计差异 -2.4，95%置信区间 -6.3至1.1，P = 0.24）。次要结果，包括患者和医生对护理的满意度以及患者焦虑，均未显示出显著的组间差异（所有P > 0.05）。干预组的患者更有可能报告SCA对患者与医生的互动有有益影响（66/164，40.2%）而非有害影响（3/164，1.8%），大多数报告无影响（95/164，57.9%）。在SCA对护理的感知影响方面也观察到类似模式。在两组中，医生很少报告其权威受到患者质疑（干预组：2/188，1.1%；对照组：4/184，2.2%）。虽然医生更多地认为SCA有帮助而非无帮助，但大多数表示它对此次就诊既无帮助也无妨碍。
我们没有发现证据表明SCA能提高急性护理环境中患者与医生互动或护理的满意度。相比之下，患者及其主治医生大多将SCA的影响描述为有益的。我们的研究未发现文献中常见的使用SCA的负面影响，如焦虑增加或对医护人员信任降低。
德国临床试验注册中心DRKS00028598；https://drks.de/search/en/trial/DRKS00028598/entails。
国际注册报告识别码（IRRID）：RR2 - 10.1186/s13063 - 022 - 06688 - w。
