The DOI matches its Crossref record; 31 of the 31 references it cites were found in a registry or an index.
Digital and online symptom checkers and health assessment/triage services for urgent health problems: systematic review
Open accessAbstract
Objectives: In England, the NHS111 service provides assessment and triage by telephone for urgent health problems. A digital version of this service has recently been introduced. We aimed to systematically review the evidence on digital and online symptom checkers and similar services. Design: Systematic review. Data sources: We searched Medline, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Management Information Consortium, Web of Science and ACM Digital Library up to April 2018, supplemented by phrase searches for known symptom checkers and citation searching of key studies. Eligibility criteria: Studies of any design that evaluated a digital or online symptom checker or health assessment service for people seeking advice about an urgent health problem. Data extraction and synthesis: Data extraction and quality assessment (using the Cochrane Collaboration version of QUADAS for diagnostic accuracy studies and the National Heart, Lung and Blood Institute tool for observational studies) were done by one reviewer with a sample checked for accuracy and consistency. We performed a narrative synthesis of the included studies structured around pre-defined research questions and key outcomes. Results: We included 29 publications (27 studies). Evidence on patient safety was weak. Diagnostic accuracy varied between different systems but was generally low. Algorithm-based triage tended to be more risk averse than that of health professionals. There was very limited evidence on patients’ compliance with online triage advice. Study participants generally expressed high levels of satisfaction, although in mainly uncontrolled studies. Younger and more highly educated people were more likely to use these services. Conclusions: The English ‘digital 111’ service has been implemented against a background of uncertainty around the likely impact on important outcomes. The health system may need to respond to short-term changes and/or shifts in demand. The popularity of online and digital services with younger and more educated people has implications for health equity. PROSPERO registration number: CRD42018093564.
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“Research indicates that, although symptom checkers seem to be easy to use and well-accepted by most users [30,31], the diagnostic performance varies significantly between different symptom checkers and has been interpreted as low to moderate at best [32,33].”
From Diagnostic Performance of an App-Based Symptom Checker in Mental Disorders: Comparative Study in Psychotherapy Outpatients (2022) · cites this paper as [32]
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“We considered some major limitations of previous studies [32] given that we collected real-world patient data, which comes closer to the current intended laypeople-oriented application of symptom checkers.”
From Diagnostic Performance of an App-Based Symptom Checker in Mental Disorders: Comparative Study in Psychotherapy Outpatients (2022) · cites this paper as [32]
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MethodSelf-citationEvaluation of symptom checkers for self diagnosis and triage: audit study
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“Studies either evaluated a single system or multiple systems.(6) 21 We found only one study of a symptom checker specifically intended for the assessment of children’s symptoms, a development of the Strategy for Off-Site Rapid Triage system for influenza-like illness.”
BackgroundInfluentialElectronic healthcare: a study of people's readiness and attitude toward performing self‐diagnosis
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BackgroundResultInfluentialImpact of the urgent care telephone service NHS 111 pilot sites: a controlled before and after study
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“For example, an evaluation of the NHS111 telephone service at four pilot sites and three control sites found that in its first year the service was not successful in reducing 999 emergency calls or in shifting patients from emergency to urgent care.(5) A recent study of 23 symptom checker algorithms providing diagnost…”
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“Patients with low to medium levels of education tended to be motivated toward indirect e-consultation (which involves contact with a health professional via email), mainly to reduce uncertainty.(27) Evidence from included studies suggests that users of e-consultation were more likely to be young,(7) 24–26 employed(20)…”
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Items 101–200 of 217
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InfluentialUsing conversant artificial intelligence to improve diagnostic reasoning: ready for prime time?
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Reorganization of the Danish out-of-hours primary care – a descriptive study
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“…and several initiatives have been taken internationally to sustain acute unplanned primary care, such as additional services and digital tools [5–7]. the reasons for reorganizing out-of-hours (OOh) care are not unique to Denmark; all neighboring countries struggle with high demand, lack of…”
The Utility of a Pediatric COVID-19 Online Forward Triage Tool in Switzerland
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“The implications of creating false positives are often underestimated, with most symptom checker development taking a conservative approach, resulting in systems typically being more risk averse than health care practitioners [59-61].”
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“…in navigating health information play critical roles in shaping user experiences and engagement with symptom checker apps [3-7 There is limited and partly conflicting evidence to conclude whether symptom checker app use directly prompts HRB, such as seeking professional health care [3,9,13,16,17].”
InfluentialInformationstechnologie und E-Health zur Verbesserung der Patientensicherheit
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RetractedCan clinical decision support systems be an asset in medical education? An experimental approach
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“Between 2019 and 2023 alone there have been 6 literature or scoping reviews evaluating published studies of their performance [26,46-50], with the same conclusions being drawn that there remains no confirmation of their assumed potential benefits.”
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“…to avoid patient safety incidents. some countries introduced symptom checkers for self-advice, but the accuracy of such products vary significantly [39,40]. furthermore, artificial intelligence-based solutions able to synthesize multiple symptoms are being introduced in some healthcare systems…”
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“There is also previous research regarding accuracy in digital and online symptom checkers (Chambers et al., 2019; Wallace et al., 2022).”
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“Studies regarding the effectiveness of generic symptom checkers have shown variable levels of system validity [23,24,29,40], and it cannot be assumed that these research findings translate to an mHealth system with a well-defined scope, such as DART with MSDs.”
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“10,11 Hennemann et al. used a symptom checker to look at accuracy of diagnosis for mental health disorders, 14 which may show some promise in aiding clinical diagnoses, but their study did not triage patients.”
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“In recent years, there has been a broad proliferation of online symptom checkers and medical triage solutions as many patients seek web-based medical guidance prior to engaging with their health care provider (White and Horvitz, 2009; Semigran et al., 2015; Chambers et al., 2019; Dunn, 2020).”
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Sampietro-Colom, L., Fernández-Barceló, C., Abbas, I., Valdasquin, B., Rabasseda, N., García‐Lorenzo, B., Sánchez, M., Sans-Corrales, M., García, N., & Granados, A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192113873
“Though few similar online and smartphones DAs already exist [22], weak scientific evidence of their effectiveness is available [30].”
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Artificial Autonomy or Relational Intelligence
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From One-Way Mirror to Two-Way Street
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Independent Living With(out) Privacy
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Metadata
- Authors
- Chambers, D., Cantrell, A. J., Johnson, M., Preston, L., Baxter, S. K., Booth, A., & Turner, J.
- Affiliations
- University of Sheffield (GB)
- Corresponding author
- Chambers, Duncan
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2019-08
- Volume
- 9
- Issue
- 8
- Pages
- e027743
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC6688675
- OpenAlex
- W2965593496
- Cited by
- 218
- References
- 31
- Citations by year
- 2026: 28 · 2025: 24 · 2024: 27 · 2023: 46 · 2022: 37 · 2021: 27 · 2020: 28 · 2019: 1
- FWCI
- 3.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMJ Open (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Health Services and Delivery Research Programme
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Keywords
- telephone triage, diagnostic accuracy, patient safety, patient satisfaction, health equity, digital health services
- MeSH terms
- England, Health Services Accessibility, Health Services Research, Humans, Quality of Health Care, Triage, Hotlines, Telemedicine, Information Seeking Behavior
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