Accepted for/Published in: JMIR Human Factors
Date Submitted: May 30, 2023
Date Accepted: Nov 20, 2023
Are there differences between the diagnostic test advice of an online triage tool and a general practitioner? A vignette based qualitative study on the decision-making for sexual transmitted infections tests
ABSTRACT
Background:
Online triage tools for STI testing can potentially be used as a substitute for the triage that GPs perform to lower their work pressure. The studied tool is based on medical guidelines. The same guidelines support the decision-making process of the GP as well. However, research showed that GPs did not always adhere to those guidelines. To have an online triage tool of high quality that results in an efficient care process it is important to learn more about the decision-making process of the GP.
Objective:
The first objective is to identify if the advice of the studied online triage tool aligns with the daily medical practice of the GP. The second objective is to learn which factors influence the GPs decision regarding a referral for diagnostic testing. In addition, the research gives insight into the GP's decision-making process.
Methods:
A qualitative vignette-based study with semi-structured interviews was performed. Six vignettes each representing a patient case were discussed with the participants (GPs). The participants needed to think aloud if they would advise an STI test for the patient or not and why they would advise this. A thematic analysis was performed on the transcripts of the interviews. The patient cases of the vignettes were also passed through the triage online triage tool resulting in advice to test or not for an STI. A comparison was made between the advice of the tool and the participants.
Results:
Ten interviews were performed, participants (GPs) had a mean age of 48.30 (SD = 11.88). For three vignettes the advice of the online triage tool and all participants was the same. For those vignettes, the patient's risk factors were sufficiently clear for the participants to advise the same as the online tool. For three vignettes the advice of the online tool differed from the advice from the participants. Patient-related factors that influenced the decision-making process of the participant were anxiety of the patient, young age and the willingness to be tested. Participants would test at a lower threshold than the triage tool due to those factors. Sometimes, participants wanted to have more information than was provided in the vignette or they would like to do a physical examination. All those elements were not part of the online triage tool.
Conclusions:
The advice to test for a diagnostic STI test differed between an online triage tool and a GP. The online triage tool took only medical guidelines into account, whilst the GP was open to discussion. The GPs decision-making process was influenced by the patient’s anxiety, willingness to test and age. Based on these first results, we believe that the online triage tool for STI testing can support the GP and could even replace the consultation in future. Further research must substantiate how this can be done safely.
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