دورية أكاديمية
أعرض في EDS

Assessment of Diagnosis and Triage in Validated Case Vignettes Among Nonphysicians Before and After Internet Search.

التفاصيل البيبلوغرافية
العنوان: Assessment of Diagnosis and Triage in Validated Case Vignettes Among Nonphysicians Before and After Internet Search.
المؤلفون: Levine DM; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts., Mehrotra A; Harvard Medical School, Boston, Massachusetts.; Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
المصدر: JAMA network open [JAMA Netw Open] 2021 Mar 01; Vol. 4 (3), pp. e213287. Date of Electronic Publication: 2021 Mar 01.
نوع المنشور: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Chicago, IL : American Medical Association, [2018]-
مواضيع طبية MeSH: Health Status* , Internet*, Anxiety Disorders/*diagnosis , Triage/*methods, Anxiety Disorders/psychology ; Female ; Humans ; Male ; Middle Aged ; Reproducibility of Results ; Surveys and Questionnaires
مستخلص: Importance: When confronted with new medical symptoms, many people turn to the internet to understand why they are ill as well as whether and where they should get care. Such searches may be harmful because they may facilitate misdiagnosis and inappropriate triage.
Objective: To empirically measure the association of an internet search for health information with diagnosis, triage, and anxiety by laypeople.
Design, Setting, and Participants: This survey study used a nationally representative sample of US adults who were recruited through an online platform between April 1, 2019, and April 15, 2019. A total of 48 validated case vignettes of both common (eg, viral illness) and severe (eg, heart attack) conditions were used. Participants were asked to relay their diagnosis, triage, and anxiety regarding 1 of these cases before and after searching the internet for health information.
Exposures: Short, validated case vignettes written at or below the sixth-grade reading level randomly assigned to participants.
Main Outcomes and Measures: Correct diagnosis, correct triage, and flipping (changing) or anchoring (not changing) diagnosis and triage decisions were the main outcomes. Multivariable modeling was performed to identify patient factors associated with correct triage and diagnosis.
Results: Of the 5000 participants, 2549 were female (51.0%), 3819 were White (76.4%), and the mean (SD) age was 45.0 (16.9) years. Mean internet search time was 12.1 (95% CI, 10.7-13.5) minutes per case. No difference in triage accuracy was found before and after search (74.5% vs 74.1%; difference, -0.4 [95% CI, -1.4 to 0.6]; P = .06), but improved diagnostic accuracy was found (49.8% vs 54.0%; difference, 4.2% [95% CI, 3.1%-5.3%]; P < .001). Most participants (4254 [85.1%]) were anchored on their diagnosis. Of the 14.9% of participants (n = 746) who flipped their diagnosis, 9.6% (n = 478) flipped from incorrect to correct and 5.4% (n = 268) flipped from correct to incorrect. The following groups had an increased rate of correct diagnosis: adults 40 years or older (eg, 40-49 years: 5.1 [95% CI, 0.8-9.4] percentage points better than those aged <30 years; P = .02), women (9.4 [95% CI, 6.8-12.0] percentage points better than men; P < .001), and those with perceived poor health status (16.3 [95% CI, 6.9-25.6] percentage points better than those with excellent status; P = .001) and with more than 2 chronic diseases (6.8 [95% CI, 1.5-12.1] percentage points better than those with 0 conditions; P = .01).
Conclusions and Relevance: This study found that an internet search for health information was associated with small increases in diagnostic accuracy but not with triage accuracy.
References: JAMA Netw Open. 2019 Dec 2;2(12):e1918561. (PMID: 31880791)
Am J Med. 2018 Oct;131(10):1250.e1-1250.e10. (PMID: 29730361)
J Med Internet Res. 2014 Oct 07;16(10):e224. (PMID: 25348028)
Telemed J E Health. 2012 Apr;18(3):213-8. (PMID: 22364307)
Lancet. 2018 Nov 24;392(10161):2263-2264. (PMID: 30413281)
BMJ Open. 2019 Aug 1;9(8):e027743. (PMID: 31375610)
BMJ. 2006 Dec 2;333(7579):1143-5. (PMID: 17098763)
BMJ. 2015 Jul 08;351:h3480. (PMID: 26157077)
BMJ. 2015 Jul 08;351:h3727. (PMID: 26156750)
J Gen Intern Med. 2019 Sep;34(9):1884-1891. (PMID: 31228051)
J Med Internet Res. 2014 Jan 16;16(1):e16. (PMID: 24434479)
Ann Intern Med. 2003 Dec 16;139(12):987-95. (PMID: 14678918)
NPJ Digit Med. 2019 Nov 11;2:110. (PMID: 31728417)
Cyberpsychol Behav. 2004 Oct;7(5):497-510. (PMID: 15667044)
JAMA Intern Med. 2016 Dec 1;176(12):1860-1861. (PMID: 27723877)
J Fam Pract. 2000 Feb;49(2):147-52. (PMID: 10718692)
Ann Intern Med. 2007 Mar 6;146(5):317-25. (PMID: 17339617)
تواريخ الأحداث: Date Created: 20210329 Date Completed: 20210608 Latest Revision: 20210608
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC8008286
DOI: 10.1001/jamanetworkopen.2021.3287
PMID: 33779741
قاعدة البيانات: MEDLINE
الوصف
تدمد:2574-3805
DOI:10.1001/jamanetworkopen.2021.3287