Moet Ik Naar De Dokter

Het hulpmiddel met antwoord op de vraag of u naar de dokter moet

Assessment report of the app “Moet ik naar de dokter?”

Authors: Mout P, Kruyswijk M, Runia F.

Introduction

The starting point for this assessment was the research report by IQ-healthcare from February 2014. We investigated to what extent the identified shortcomings, as described in the research report, have been resolved and which ones still exist. The assessment was mainly analyzed from the perspective of the safety of self-triage.

Method

The app was assessed by a group of general practitioners with knowledge and experience in emergency care, triage, research, and audit. The app was assessed against the most recent version of the NHG-TriageWijzer but was also regularly compared to the previous version. The assessment used the access granted to us to the CMS of the MINDD app.

Results

We have the impression that the app has been adjusted in many places since the IQ-healthcare report was released, whether or not in response to the report. The conclusion of IQ-healthcare that the app is safe does not need to be revised. We do want to make some nuance on five points:

  1. In some places indicated above, the app is potentially unsafe. This unsafety sometimes concerns triage (e.g. slow pulse), but sometimes also the given advice (e.g. chest pain).
  2. Some advice seems to contradict itself (e.g. Paralysis).
  3. In the NHG-TriageWijzer, U5 is described as follows: “There is no chance of short-term damage. Assessment by a doctor is not necessary or can wait. Action: information and advice and/or referral to own general practitioner/treating physician”. We have the impression that the MINDD app advises a U5 when an assessment by a doctor is not necessary. U4 is (sometimes) given when a doctor’s opinion is desirable but without time pressure. Examples: Itching genitals; Fear of STD. There is nothing wrong with that, and it is safe. The consequence is that the U4 and U5 in the NHG TriageWijzer and the MINDD app do not fully match.
  4. Actually, the MINDD app has only two outcomes: Go to the doctor now (possibly via 112) or do not go to the doctor now. In terms of the NHG-TriageWijzer: U5 or no-U5. Differentiation in the higher urgencies is then not really necessary. When assessing via the CMS, we have noticed that many situations score higher than strictly necessary according to the NHG-TriageWijzer. For the app within its current scope, that does not cause any problems. However, the app is therefore not suitable for a different use than it was built for. A potentially interesting application for the app could be to use it as a safety screening when patients themselves schedule an appointment in the general practitioner’s agenda. Without extensive adaptation of the content, that is not possible.
  5. We have encountered outdated triage criteria in several places. Our conclusion is that the current app has not been updated with the latest version of the NHG-TriageWijzer. Procedures will have to be developed to keep the MINDD app up to date.

Conclusion/Discussion

From the results, it can be concluded that the conclusion of IQ-healthcare, that the app “Moet ik naar de dokter?” is safe, does not need to be revised. The researchers have the impression that the app has been adjusted in many places since the IQ-healthcare report was released, whether or not in response to the report.

Changes after the validity study by I.Q. Healthcare and the assessment report

Based on the recommendations of the I.Q. Healthcare validation study and the evaluation of these recommendations, the entire app was checked based on the current NHG TriageWijzer (hardcopy). The changes are described in the logbook. Of course, immediately after the advice was issued, the serious complaint of chest pain was adjusted. An advice was added explicitly stating to call 112.

The app “Moet ik naar de dokter?” is now immediately updated and the changes are recorded in the logbook when a new guideline is released that provides changes to the NHG TriageWijzer.

Changes were made by adding 27 new triage questions, removing one unnecessary triage question, adjusting seventeen other triage questions, and adjusting the order of triage questions for eighteen complaints. In addition, for most complaints, the urgencies were adjusted to the specific urgency given in the NHG TriageWijzer. For safety reasons, a higher urgency than what is possible according to the NHG TriageWijzer was chosen for some complaints. This applies to, among other things, chest pain, head injury/accident, and paralysis. If there is a reduction in the urgency code, this is a shift within the urgency codes U1-U4, so the outcome will still be “see a doctor.”

The obtained triages via the CMS were analyzed in 2018, which generated more insight into the triage outcomes. In addition, the content of the triages was analyzed from a medical and user perspective, and extensive adjustments were made. This made it possible to make a safe differentiation in urgencies, which means that the urgency outcomes were adjusted more specifically.