Paule Armina, Abel Gary A, Parsons Jo, Atherton Helen
Applied Health, Warwick Medical School, University of Warwick, Coventry, UK
Department of Health and Community Science, University of Exeter, Exeter, UK.
BMJ Open. 2025 May 8;15(5):e094068. doi: 10.1136/bmjopen-2024-094068.
To evaluate the role of using outputs from patient-facing online triage tools in clinical decision-making in primary care.
Systematic review.
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.
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 were extracted, and quality assessment was conducted using the Mixed Methods Appraisal Tool. Narrative synthesis was used to analyse the findings.
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.
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.
CRD42022373944.
评估面向患者的在线分诊工具输出结果在基层医疗临床决策中的作用。
系统评价。
检索了Medline、Embase、护理学与健康相关文献累积索引、科学引文索引和Scopus，查找2002年1月1日至2022年12月31日发表的文献，并更新至2024年11月底发表的文献。
纳入任何设计的研究，只要该研究调查基层医疗临床医生如何根据使用在线分诊工具报告的患者问题做出临床决策。
提取数据，并使用混合方法评估工具进行质量评估。采用叙述性综合分析研究结果。
纳入14项研究，这些研究分别在英国（n = 9）、瑞典（n = 3）和西班牙（n = 2）开展。没有研究将临床决策作为一项结果进行考察。与临床决策影响相关的结果分为三类：患者临床结果（n = 9）、基层医疗从业者体验（n = 11）和医疗系统结果（n = 14）。研究报告称，针对患者问题能做出更快的临床决策。其他研究报告称，随着患者学会“操纵”系统，临床医生会提供不必要的紧急预约。临床医生在能够获取额外信息（如照片附件）时，对处理患者请求感到自信。此外，临床医生的时间从处理临床价值有限的预约中解放出来。相反，在线分诊被视为工作流程中的额外步骤。
临床医生应意识到，使用在线分诊工具时他们的决策过程可能会有所不同。开发者可利用这些研究结果来提高工具的可用性，以辅助临床决策。未来的研究应聚焦于全科医疗中面向患者的在线分诊工具以及临床决策过程。
PROSPERO注册号：CRD42022373944。
