Minor ailments in out-of-hours primary care: An observational study

Lina Welle-Nilsen

Tone Morken

Steinar Hunskaar

Anne Granas

^{National Centre for Emergency Primary Health Care, Uni Health, Bergen}

^{Research Group for General Practice, Department of Public Health and Primary Health Care, University of Bergen}

^{Centre for Pharmacy, Department of Public Health and Primary Health Care, University of Bergen, Norway}

Correspondence: Lina Kristin Welle-Nilsen, National Centre for Emergency Primary Health Care, Uni Health, Kalfarveien 31, 5018 Bergen, Norway. E-mail: moc.liamg@neslinellew.anil

Received 2009 Nov 2; Accepted 2010 Nov 29.

Abstract

Background

Many consultations are partly or totally spent on minor ailments. A minor ailment is defined as a health complaint which, by simple actions, patients could handle themselves.

Objective

To investigate the prevalence, type of conditions, and time spent on minor ailments in consultations in out-of-hours care in Norway.

Design and setting

An observational study of consultations at six out-of-hours primary care centres was carried out during evenings and weekends in November and December 2008. Main outcome measures were number and type of minor ailments, as well as consultation time. The minor ailments were predefined by a list of conditions. Conditions which, by certain pre-set criteria, still needed a doctor's professional advice were reclassified as “no minor ailment”.

Results

A total of 210 consultations were observed. The patients’ mean age was 28 years (range 0–94). Cough, fever, sore throat, upper respiratory tract infection, and earache contributed 76% of the 211 minor ailments registered. After reclassification, 58 (28%) of the 210 consultations registered were classified as partly or totally a minor ailment. These minor ailments represented 18% of the doctors’ total consultation time in the 210 observed consultations.

Conclusion

More than a quarter of the observed consultations were partly or totally spent on addressing minor ailments. This shows a potential for empowering patients to rely on self-care also for minor ailments in out-of-hours primary care.

Key Words: Observation, out-of-hours medical care, self care

Abstract

Minor ailments are conditions which, with simple actions, patients could handle themselves.

In all, 28% of the observed consultations in out-of-hours primary care were partly or totally spent on addressing minor ailments.
There is a significant potential for reducing time spent on counselling patients seeking help for minor ailments by empowering patients to rely increasingly on self-care.

Minor ailments (MA) contribute to a considerable amount of the total workload for general practitioners and thereby represent poor utilization of doctors’ resources [1–5]. A British study of consultations in general practice showed that doctors classified 7% of the consultations as “unnecessary”, and that the minor ailments could be handled by a pharmacist [6].

In Norway, the purpose of primary care out-of-hours emergency services is to assess contacts regarding need for immediate medical care and to perform essential diagnostics and treatment for acute illness or injury [7]. Trained nurses usually prioritize each patient by severity into the colours red, yellow, and green (triage) according to the Norwegian Index for Medical Emergency Assistance [8]. Red represents an “acute” response for a life-threatening condition with the highest priority. Yellow is defined as an “urgent” response, which should lead to clinical assessment without much delay. Green is given to a contact that can wait until a physician is otherwise available (often hours) or where the patient should preferably visit a general practitioner (GP) the following day (“not urgent” response). Nearly 80% of all contacts in Norwegian out-of-hours care are in the green category [9].

Norwegian research on minor ailments has not been found, either concerning general practice or out-of-hours care. We consider it to be of interest to investigate whether patient contacts for minor ailments, from a doctor's perspective, constitute a potential area for improvement of the out-of-hours care in Norway, both for the service of the patients and in order to make better use of the scarce resources in terms of doctors.

Minor ailments have been defined in several ways in the literature [1]. Some studies have defined minor ailments according to a list of 12 conditions as a reflection of available over-the-counter (OTC) drugs, or as a reflection of pharmacists’ extended permission to dispense prescription drugs (“care at the chemist” scheme) [10,11]. In the present study we have chosen the following definition of minor ailment: A health complaint which, with simple actions, patients can handle themselves. Simple actions in this context are self-care which does not involve a doctor; for instance seeking advice in a pharmacy, asking acquaintances, taking OTC drugs, staying in bed, or using self-certified work absence.

The aim of the study was to investigate the prevalence, type of conditions, and time spent on minor ailments in consultations in out-of-hours care in Norway.

Acknowledgements

The authors would like to thank all the out-of-hours primary care centres as well as all the doctors and patients who took part in this research project.

Acknowledgements

References

1. All Party Parliamentary Group on Primary Care & Public Health. Inquiry report on GP access & health improvement in primary care. London: All Party Parliamentary Group; 2008. Available at: . [PubMed]
2. Yadav SPharmacists rather than GPs should be first contact for minor ailments, report says. BMJ. 2008;337:a775.[PubMed][Google Scholar]
3. Proprietary Association of Great Britain. Unlocking self care, Annual Review 2008. London: PAGB; 2008. Available at: . [PubMed]
4. Department of Health. Pharmacy in England: Building on strengths – delivering the future – proposals for legislative change. London: Department of Health; 2008. Available at: . [PubMed]
5. Morris C, Cantrill J, Weiss MGPs’ attitudes to minor ailments. Fam Pract. 2001;18:581–5.[PubMed][Google Scholar]
6. Hammond T, Clatworthy J, Horne RPatients’ use of GP and community pharmacists in minor illness: A cross-sectional questionnaire-based study. Fam Pract. 2004;21:146–9.[PubMed][Google Scholar]
7. Helse- og omsorgsdepartementet. Oslo: Ministry of Health and Care Services; 2005. Forskrift om krav til akuttmedisinske tjenester utenfor sykehus (Regulation on pre-hospital emergency medicine services). FOR 2005-03-18 no. 252 (in Norwegian) Available at: . [PubMed]
8. Norwegian Medical Association: Norsk indeks for medisinsk nødhjelp (Norwegian Index of Emergency Medical Assistance) 21st. Stavanger: Åsmund S Lærdal A/S, The Laerdal Foundation for Acute Medicine; 2005. [PubMed]
9. Eikeland OJ Vakttårnprosjektet. Epidemiologiske data frå legevakt. Samlerapport frå 2007. (The Watchtower project. Epidemiological data from casualty clinics. Main report from 2007) Bergen: Nasjonalt kompetansesenter for legevaktmedisin; 2008. [PubMed][Google Scholar]
10. Hassell K, Whittington Z, Cantrill J, et al Managing demand: Transfer of management of self limiting conditions from general practice to community pharmacies. BMJ. 2001;323:146–7.[Google Scholar]
11. Whittington Z, Cantrill J, Hassell K, et al Community pharmacy management of minor conditions – the “care at the chemist” scheme. Pharm J. 2001;266:425–8.[PubMed][Google Scholar]
12. Nieber T, Hansen E, Bondevik G, Hunskaar S, Blinkenberg J, Thesen J, et al Organization of Norwegian out-of-hours primary health care services. Tidsskr Nor Laegeforen. 2007;127:1335–8.[PubMed][Google Scholar]
13. Smith F Research methods in pharmacy practice. London: Pharmaceutical Press; 2002. [PubMed][Google Scholar]
14. Statistics Norway [database on the Internet] 2008. [cited 01.06.09]. Available at:
15. Hansen E, Hunskaar SDevelopment, implementation, and pilot study of a sentinel network (“The Watchtowers”) for monitoring emergency primary health care activity in Norway. BMC Health Serv Res. 2008;8:62.[Google Scholar]
16. Hansen E, Zakariassen E, Hunskaar SSentinel monitoring of activity of out-of-hours services in Norway in 2007: An observational study. BMC Health Serv Res. 2009;9:123.[Google Scholar]
17. Hugenholtz M, Bröer C, Van Daalen RApprehensive parents: A qualitative study of parents seeking immediate primary care for their children. Br J Gen Pract. 2009;59:173–9.[Google Scholar]