Patient-facing online triage tools and clinician decision-making: a systematic review.

OBJECTIVE

To evaluate the role of using outputs from patient-facing online triage tools in clinical decision-making in primary care.

DESIGN

Systematic review.

DATA SOURCES

Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Scopus were searched for literature published between 1 January 2002 and 31 December 2022 and updated for literature published up to end of November 2024.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies of any design are included where the study investigates how primary care clinicians make clinical decisions in response to patient concerns reported using online triage tools.

DATA EXTRACTION AND SYNTHESIS

Data were extracted, and quality assessment was conducted using the Mixed Methods Appraisal Tool. Narrative synthesis was used to analyse the findings.

RESULTS

14 studies were included, which were conducted in the UK (n=9), Sweden (n=3) and Spain (n=2). There were no studies that examined clinical decision-making as an outcome. Outcomes relating to the impact on clinical decision-making were grouped into three categories: patient clinical outcomes (n=9), primary care practitioner experience (n=11) and healthcare system outcomes (n=14). Studies reported faster clinical decisions made in response to patient concerns. Other studies reported clinicians offering unnecessary urgent appointments as patients learnt to 'game' the system. Clinicians felt confident managing patient requests as they can access additional information (such as a photo attachment). Moreover, clinicians' time was freed up from appointments with limited clinical value. Contrarily, online triage was perceived as an additional step in the workflow.

CONCLUSION

Clinicians should be aware that their decision-making processes are likely to differ when using online triage tools. Developers can use the findings to improve the usability of the tools to aid clinical decision-making. Future research should focus on patient-facing online triage tools in general practice and the process of clinical decision-making.

PROSPERO REGISTRATION NUMBER

CRD42022373944.