JMIR Publications

ABSTRACT

Background:

Insight into patient attitudes and behaviors towards self-triage through connectivity apps in urgent direct-to-consumer telemedicine consultations is still insufficiently explored.

Objective:

To analyze behavior patterns within the screen-pathways of a symptom-based self-triage mobile application's decision algorithm during remote urgent care assessments.

Methods:

This was an observational, retrospective, and unicentric study performed between May 2022 and Dezember 2023. Inclusion criteria were age over 18 years old, and spontaneous seeking virtual emergency care through the EINSTEIN CONECTA 2.0 app. Patients with connecting problems who were not allowed to complete the encounter were excluded. Primary outcome focuses on several key metrics to understand user interaction with the symptom-based self-management mobile app during urgent care assessments: the frequency of accesses to existing screens, the number of times users return to a previous screen, accesses to alternative, and time spent in each screen. The algorithm of the app is designed to utilize scientific evidence related to symptoms to guide users towards appropriate referral to the emergency department. Every complaint registered is addressed through a distinct flow algorithm designed for that specific issue.

Results:

From 62,006 patients (mean age 36.51 + 10.53, 54.67% female) connected to Telemedicine Center, the self-triage generated 194,976 flows algorithms, of which 80,451 (41.26%) involved to virtual assessment, and the others were referred to the emergency department. Of the patients evaluated virtually, 11,044 (13.72%) were referred for in-person evaluation. Of the total, 22,875 (36.89%) were stayed to the screening flow once. Meanwhile, 13,734 (22.14%) choose two different screening flows, 8,080 (13.03%) experienced three flows, and the remainder of the patients were exposed to between four to forty-one flows. Only 1,123 (2.72%) patients opted to navigate back to previous screens more than once while engaged within a particular pathway. Users spent an average of 70.95 (± 65.26) seconds on their initial access. The average duration spent on each screen amounted to approximately 9.51 (± 12.84) seconds, irrespective of the number of pathways accessed.

Conclusions:

Approximately one-third of patients follow the self-triage app's recommendations by completing the suggested pathway once. Most patients seek out an alternative flow during self-triage, though reverting to a previous screen within the same flow is infrequent. Future studies should focus on enhancing the self-triage mechanisms within telemedicine frameworks.