A cohort study of influences, health outcomes and costs of patients' health seeking behaviour for minor ailments from primary and emergency care settings

M C Watson, J Ferguson, G R Barton, V Maskrey, A Blyth, V Paudyal, C M Bond, R Holland, T Porteous, T H Sach, D Wright, S Fielding

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Abstract

Objectives To compare health- and cost-related outcomes of consultations for symptoms suggestive of minor ailments in emergency departments (EDs), general practices and community pharmacies. Design Observational study; prospective cohort design. Setting EDs (n=2), general practices (n=6) and community pharmacies (n=10) in a mix of rural/urban and deprived/affluent areas across North East Scotland and East Anglia. Participants Adults (> 18 years) presenting between 09.00-18.00 (Monday – Friday) in general practices and 09.00-18.00 (Monday-Saturday) in pharmacies and EDs with > 1 of the following: musculoskeletal pain; eye discomfort; gastro-intestinal disturbance; or upper respiratory tract-related symptoms. Interventions Participants completed three questionnaires: baseline (prior to index consultation); satisfaction with index consultation (two measures); and follow-up (2 weeks after index consultation). Main outcome measures Symptom resolution, quality of life, costs, satisfaction and influences on care-seeking behaviour. Results 377 patients participated, recruited from EDs (81), general practices (162) and community pharmacies (134). The 2-week response rate was 70.0% (264/377). Symptom resolution was similar across all three settings: ED (37.3%), general practice (35.7%) and pharmacy (44.3%). Mean overall costs per consultation were significantly lower for pharmacy (£29.30 (95% CI £21.60 to £37.00)) compared with general practice (£82.34 (95% CI £63.10 to £101.58)) and ED (£147.09 (95% CI £125.32 to £168.85)). Satisfaction varied across settings and by measure used. Compared with pharmacy and general practice use, ED use was significantly (p<0.001) associated with first episode 4 and short duration of symptom(s), as well as higher levels of perceived seriousness and urgency for seeking care. Convenience of location was the most commonly reason for choice of consultation setting. Conclusions These results suggest similar health-related outcomes and substantially lower costs with pharmacy consultations for minor ailments. Effective strategies are now needed to shift demand for minor ailment management away from EDs and general practices to the community pharmacy setting.
Original languageEnglish
Article numbere006261
JournalBMJ Open
Volume5
Issue number2
DOIs
Publication statusPublished - 18 Feb 2015

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Emergency Medical Services
General Practice
Health Care Costs
Primary Health Care
Cohort Studies
Hospital Emergency Service
Pharmacies
Referral and Consultation
Health
Costs and Cost Analysis
Musculoskeletal Pain
Scotland
Respiratory System
Quality of Life

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A cohort study of influences, health outcomes and costs of patients' health seeking behaviour for minor ailments from primary and emergency care settings. / Watson, M C; Ferguson, J; Barton, G R; Maskrey, V; Blyth, A; Paudyal, V; Bond, C M; Holland, R; Porteous, T; Sach, T H; Wright, D; Fielding, S.

In: BMJ Open, Vol. 5, No. 2, e006261, 18.02.2015.

Research output: Contribution to journalArticle

Watson, MC, Ferguson, J, Barton, GR, Maskrey, V, Blyth, A, Paudyal, V, Bond, CM, Holland, R, Porteous, T, Sach, TH, Wright, D & Fielding, S 2015, 'A cohort study of influences, health outcomes and costs of patients' health seeking behaviour for minor ailments from primary and emergency care settings', BMJ Open, vol. 5, no. 2, e006261. https://doi.org/10.1136/bmjopen-2014-006261
Watson, M C ; Ferguson, J ; Barton, G R ; Maskrey, V ; Blyth, A ; Paudyal, V ; Bond, C M ; Holland, R ; Porteous, T ; Sach, T H ; Wright, D ; Fielding, S. / A cohort study of influences, health outcomes and costs of patients' health seeking behaviour for minor ailments from primary and emergency care settings. In: BMJ Open. 2015 ; Vol. 5, No. 2.
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abstract = "Objectives To compare health- and cost-related outcomes of consultations for symptoms suggestive of minor ailments in emergency departments (EDs), general practices and community pharmacies. Design Observational study; prospective cohort design. Setting EDs (n=2), general practices (n=6) and community pharmacies (n=10) in a mix of rural/urban and deprived/affluent areas across North East Scotland and East Anglia. Participants Adults (> 18 years) presenting between 09.00-18.00 (Monday – Friday) in general practices and 09.00-18.00 (Monday-Saturday) in pharmacies and EDs with > 1 of the following: musculoskeletal pain; eye discomfort; gastro-intestinal disturbance; or upper respiratory tract-related symptoms. Interventions Participants completed three questionnaires: baseline (prior to index consultation); satisfaction with index consultation (two measures); and follow-up (2 weeks after index consultation). Main outcome measures Symptom resolution, quality of life, costs, satisfaction and influences on care-seeking behaviour. Results 377 patients participated, recruited from EDs (81), general practices (162) and community pharmacies (134). The 2-week response rate was 70.0{\%} (264/377). Symptom resolution was similar across all three settings: ED (37.3{\%}), general practice (35.7{\%}) and pharmacy (44.3{\%}). Mean overall costs per consultation were significantly lower for pharmacy (£29.30 (95{\%} CI £21.60 to £37.00)) compared with general practice (£82.34 (95{\%} CI £63.10 to £101.58)) and ED (£147.09 (95{\%} CI £125.32 to £168.85)). Satisfaction varied across settings and by measure used. Compared with pharmacy and general practice use, ED use was significantly (p<0.001) associated with first episode 4 and short duration of symptom(s), as well as higher levels of perceived seriousness and urgency for seeking care. Convenience of location was the most commonly reason for choice of consultation setting. Conclusions These results suggest similar health-related outcomes and substantially lower costs with pharmacy consultations for minor ailments. Effective strategies are now needed to shift demand for minor ailment management away from EDs and general practices to the community pharmacy setting.",
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AU - Watson, M C

AU - Ferguson, J

AU - Barton, G R

AU - Maskrey, V

AU - Blyth, A

AU - Paudyal, V

AU - Bond, C M

AU - Holland, R

AU - Porteous, T

AU - Sach, T H

AU - Wright, D

AU - Fielding, S

N1 - Funding This work was supported by the Pharmacy Practice Research Trust which merged with the Pharmaceutical Trust for Educational and Charitable Objects in December 2012 to form Pharmacy Research UK.

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N2 - Objectives To compare health- and cost-related outcomes of consultations for symptoms suggestive of minor ailments in emergency departments (EDs), general practices and community pharmacies. Design Observational study; prospective cohort design. Setting EDs (n=2), general practices (n=6) and community pharmacies (n=10) in a mix of rural/urban and deprived/affluent areas across North East Scotland and East Anglia. Participants Adults (> 18 years) presenting between 09.00-18.00 (Monday – Friday) in general practices and 09.00-18.00 (Monday-Saturday) in pharmacies and EDs with > 1 of the following: musculoskeletal pain; eye discomfort; gastro-intestinal disturbance; or upper respiratory tract-related symptoms. Interventions Participants completed three questionnaires: baseline (prior to index consultation); satisfaction with index consultation (two measures); and follow-up (2 weeks after index consultation). Main outcome measures Symptom resolution, quality of life, costs, satisfaction and influences on care-seeking behaviour. Results 377 patients participated, recruited from EDs (81), general practices (162) and community pharmacies (134). The 2-week response rate was 70.0% (264/377). Symptom resolution was similar across all three settings: ED (37.3%), general practice (35.7%) and pharmacy (44.3%). Mean overall costs per consultation were significantly lower for pharmacy (£29.30 (95% CI £21.60 to £37.00)) compared with general practice (£82.34 (95% CI £63.10 to £101.58)) and ED (£147.09 (95% CI £125.32 to £168.85)). Satisfaction varied across settings and by measure used. Compared with pharmacy and general practice use, ED use was significantly (p<0.001) associated with first episode 4 and short duration of symptom(s), as well as higher levels of perceived seriousness and urgency for seeking care. Convenience of location was the most commonly reason for choice of consultation setting. Conclusions These results suggest similar health-related outcomes and substantially lower costs with pharmacy consultations for minor ailments. Effective strategies are now needed to shift demand for minor ailment management away from EDs and general practices to the community pharmacy setting.

AB - Objectives To compare health- and cost-related outcomes of consultations for symptoms suggestive of minor ailments in emergency departments (EDs), general practices and community pharmacies. Design Observational study; prospective cohort design. Setting EDs (n=2), general practices (n=6) and community pharmacies (n=10) in a mix of rural/urban and deprived/affluent areas across North East Scotland and East Anglia. Participants Adults (> 18 years) presenting between 09.00-18.00 (Monday – Friday) in general practices and 09.00-18.00 (Monday-Saturday) in pharmacies and EDs with > 1 of the following: musculoskeletal pain; eye discomfort; gastro-intestinal disturbance; or upper respiratory tract-related symptoms. Interventions Participants completed three questionnaires: baseline (prior to index consultation); satisfaction with index consultation (two measures); and follow-up (2 weeks after index consultation). Main outcome measures Symptom resolution, quality of life, costs, satisfaction and influences on care-seeking behaviour. Results 377 patients participated, recruited from EDs (81), general practices (162) and community pharmacies (134). The 2-week response rate was 70.0% (264/377). Symptom resolution was similar across all three settings: ED (37.3%), general practice (35.7%) and pharmacy (44.3%). Mean overall costs per consultation were significantly lower for pharmacy (£29.30 (95% CI £21.60 to £37.00)) compared with general practice (£82.34 (95% CI £63.10 to £101.58)) and ED (£147.09 (95% CI £125.32 to £168.85)). Satisfaction varied across settings and by measure used. Compared with pharmacy and general practice use, ED use was significantly (p<0.001) associated with first episode 4 and short duration of symptom(s), as well as higher levels of perceived seriousness and urgency for seeking care. Convenience of location was the most commonly reason for choice of consultation setting. Conclusions These results suggest similar health-related outcomes and substantially lower costs with pharmacy consultations for minor ailments. Effective strategies are now needed to shift demand for minor ailment management away from EDs and general practices to the community pharmacy setting.

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DO - 10.1136/bmjopen-2014-006261

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