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

Abstract

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.

Keywords: Digital Technology; Primary Care; Primary Health Care; Triage.

Figure 1. PRISMA flow chart. Initial search for literature published between 1 January 2002 and 31 December 2022 and updated search for literature published up to 24 November 2024.*All 56 (first search) and seven (second search) excluded articles based on the intervention are articles that discuss interventions that did not meet the specific inclusion criteria, or met at least one of the exclusion criteria (not primary care tool, used to assess specific symptom (eg, dermatology), digital symptom checker, screening or providing likely diagnosis, do not inform triage by human clinician, provide access to direct consultation (without human triage) or were under development). PRISMA, Preferred Reporting Items for Systematic Reviews and Meta Analyses.