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, M. C. Bond, R. Holland, T. Porteous, T. H. Sach, D. Wright, S. Fielding

Research output: Contribution to journalArticle

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Abstract

Objectives To compare health-related 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 and 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; gastrointestinal disturbance; or upper respiratory tract-related symptoms.

Interventions Participants completed three questionnaires: baseline (prior to index consultation); satisfaction with index consultation 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% (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 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 common 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
Pages (from-to)1-14
Number of pages14
JournalBMJ Open
Volume5
Issue number2
Early online date18 Feb 2015
DOIs
Publication statusPublished - 18 Feb 2015

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

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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, M. C.; Holland, R.; Porteous, T.; Sach, T. H.; Wright, D.; Fielding, S.

In: BMJ Open, Vol. 5, No. 2, e006261, 18.02.2015, p. 1-14.

Research output: Contribution to journalArticle

Watson, MC, Ferguson, J, Barton, GR, Maskrey, V, Blyth, A, Paudyal, V, Bond, MC, 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, pp. 1-14. https://doi.org/10.1136/bmjopen-2014-006261
Watson, M. C. ; Ferguson, J. ; Barton, G. R. ; Maskrey, V. ; Blyth, A. ; Paudyal, V. ; Bond, M. C. ; 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. pp. 1-14.
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abstract = "Objectives To compare health-related 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 and 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; gastrointestinal disturbance; or upper respiratory tract-related symptoms.Interventions Participants completed three questionnaires: baseline (prior to index consultation); satisfaction with index consultation 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{\%} (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 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 common 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, M. C.

AU - Holland, R.

AU - Porteous, T.

AU - Sach, T. H.

AU - Wright, D.

AU - Fielding, S.

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N2 - Objectives To compare health-related 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 and 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; gastrointestinal disturbance; or upper respiratory tract-related symptoms.Interventions Participants completed three questionnaires: baseline (prior to index consultation); satisfaction with index consultation 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% (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 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 common 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-related 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 and 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; gastrointestinal disturbance; or upper respiratory tract-related symptoms.Interventions Participants completed three questionnaires: baseline (prior to index consultation); satisfaction with index consultation 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% (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 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 common 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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