title: A cohort study of influences, health outcomes and costs of patients' health-seeking behaviour for minor ailments from primary and emergency care settings.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Observational study; prospective cohort design.
  
  
  METHODS
  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.
  
  
  METHODS
  Participants completed three questionnaires: baseline (prior to index consultation); satisfaction with index consultation and follow-up (2 weeks after index consultation).
  
  
  METHODS
  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.
authors.affiliation: Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: M C
authors.initials: MC
authors.lastname: Watson
authors.affiliation: Emergency Department, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: J
authors.initials: J
authors.lastname: Ferguson
authors.affiliation: Health Economics Group, Norwich Medical School, Norwich, UK.
authors.forename: G R
authors.initials: GR
authors.lastname: Barton
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: V
authors.initials: V
authors.lastname: Maskrey
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: A
authors.initials: A
authors.lastname: Blyth
authors.affiliation: Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: V
authors.initials: V
authors.lastname: Paudyal
authors.affiliation: Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Bond
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: R
authors.initials: R
authors.lastname: Holland
authors.affiliation: Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: T
authors.initials: T
authors.lastname: Porteous
authors.affiliation: Health Economics Group, Norwich Medical School, Norwich, UK.
authors.forename: T H
authors.initials: TH
authors.lastname: Sach
authors.affiliation: School of Pharmacy, University of East Anglia, Norwich, UK.
authors.forename: D
authors.initials: D
authors.lastname: Wright
authors.affiliation: Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: S
authors.initials: S
authors.lastname: Fielding
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D004632:Emergency Medical Services / Q000191:economics; D004638:Emergency Treatment / Q000191:economics; D004739:England; D005260:Female; D005767:Gastrointestinal Diseases / Q000628:therapy; D058006:General Practice / Q000191:economics; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000628:therapy; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D010594:Pharmacies / Q000191:economics; D011320:Primary Health Care / Q000191:economics; D011446:Prospective Studies; D011788:Quality of Life; D012140:Respiratory Tract Diseases / Q000628:therapy; D012606:Scotland; D012720:Severity of Illness Index; D013222:State Medicine; D011795:Surveys and Questionnaires
keywords: ACCIDENT & EMERGENCY MEDICINE; HEALTH SERVICES ADMINISTRATION & MANAGEMENT; PRIMARY CARE; PUBLIC HEALTH