The Minor Ailment Study ‘MINA’
Lead Researcher – Dr Margaret Watson
The Minor Ailment Study – MINA has now been completed and a full report is available to read and download as well as an Executive Summary. Below you can find the details of the study as planned, the methodology and the questions being asked. There is an embedded copy of the final report which you can read online or download. There are also links at the bottom of the page.
The Lead researcher on the project was Dr Margaret C Watson from the University of Aberdeen in collaboration with colleagues from NHS Grampian and the University of East Anglia
Aims/Objectives
The aims of this research programme were:
- To identify and summarise empirical evaluations of community pharmacy-based minor ailments services in terms of effectiveness (patient outcomes) and cost-effectiveness.
- To identify the minor ailments that have the highest impact on the work load of high cost services (general practitioners (GPs), Emergency Department (ED) using routinely collected data.
- To seek consensus amongst health professionals in settings where minor ailments are most often treated (in general practices, community pharmacies, ED) about which ailments are regarded as minor ailments.
- To compare the effectiveness (patient outcomes) and cost-effectiveness of the different models of delivery of care for selected minor ailments in community pharmacy, general practice, and ED.
- To explore patient triggers for seeking care for selected minor ailments from community pharmacies.
- To assess the effect of pharmacy staff’s consultation and diagnostic performance in the management of selected minor ailments on patient outcome.
- To evaluate pharmacy staff’s consultation and diagnostic performance in the management of selected minor ailments.
Introduction
Minor ailments are defined as “common or self-limiting or uncomplicated conditions which can be diagnosed and managed without medical intervention.” Up to 18% of general practice workload is estimated to relate to minor ailments at a cost of £2 billion annually. Similarly, 8% of Emergency Departments (ED) consultations involve consultations each year for minor ailments costing the National Health Service (NHS) £136 million annually. Self care is “the care taken by individuals and carers towards their own health and well being, and includes the care extended to their children, family, friends and others in neighbourhoods and local communities”. (NSF for Service Change in the NHSiS, May 2005). The public is being encouraged to undertake self care where possible and to enable this, Pharmacy-based Minor Ailment Schemes (PMAS) have been introduced to provide public access to National Health Service (NHS) treatment and/or advice via pharmacist or pharmacy personnel, or where appropriate, to onward referral to other health professionals.
These schemes were introduced nationally in all community pharmacies in Scotland and Northern Ireland in 2006 and 2009, respectively. The Welsh Government will roll-out the service nationwide by 2013. In England, PMAS are specified as ‘enhanced’ services within the community pharmacy contract, which can be commissioned by the Primary Care Trusts (PCTs) after assessment of local needs.
The following proposal presents a 2-year research programme. The overall purpose of this programme is to derive evidence to inform recommendations regarding the future delivery of minor ailments services in community pharmacies in the UK. The research programme comprises several inter-linked components, each of which addresses one or more of the following research aims. The programme is led by Dr Margaret C Watson from the University of Aberdeen in collaboration with colleagues from NHS Grampian and the University of East Anglia.
Methodology
Each of the research components that formed part of the research programme are summarised below:
Systematic review
A systematic literature review was conducted to identify, collate and analyse the evidence of effectiveness and cost-related outcomes of PMAS. Standard methods were used to conduct this review which was registered with PROSPERO, the international prospective register of reviews http://www.crd.york.ac.uk/PROSPERO/) and presented according to the PRISMA http://www.prisma-statement.org/) statement which is regarded as best-practice for all health-related systematic reviews.
The systematic review was completed in 2012 and included 31 evaluations of PMAS, all of which were conducted in the UK. The final report of the systematic review is available here In general; the quality of the evaluations and reporting was poor. PMAS have proliferated across the UK but no evidence of their use was identified in other countries. Whilst there was minimal evidence of the direct impact of these schemes on users’ health, relatively low re-consultation rates were reported and these are encouraging because they suggest that patients have not needed to seek additional consultations with health service providers after they have consulted a PMAS. Very low rates of urgent referral also suggest that the ailments presented to the PMAS were appropriate for treatment within a community pharmacy.
Where evaluated, the average cost of consultations with PMAS was lower than general practice consultation costs. Robust economic evaluations are needed to derive definitive conclusions about the value for money provided by these schemes for the NHS.
Routine Data Collection and Analysis
Data were collected from two general practices in Grampian, North East Scotland, and one ED in Aberdeen city. These data were collected for all consultations which occurred at these sites during a one-week period in early 2012. The purpose of this research component was to generate anonymised consultation data which would then be used in the next part of the research programme, to identify which of these consultations could have been categorised as a minor ailment, and to identify the types of minor ailments that were occurring most frequently in general practice and ED.
Uni- and Multi-disciplinary Consensus
The anonymised consultations were allocated to three consensus panels: two panels were uni-disciplinary and one was multi-disciplinary.
Uni-disciplinary Consensus Panels
One panel comprised general practitioners (GPs) and the other ED doctors. Each GP consultation was allocated to a minimum of two GPs to assess independently to determine whether they categorised it as a minor ailment or not, and whether it could be treated in a community pharmacy or not. A similar process was used with all the ED consultations. The purpose of these panels was to seek consensus amongst these health professionals regarding the types of minor ailments that were presenting in general practice and ED that could potentially be treated in the community pharmacy setting. An additional purpose of this exercise was to estimate the number of consultations for minor ailments as a percentage of the total number of consultations (also known as the prevalence).
Multi-disciplinary Consensus Panel
A multi-disciplinary consensus panel was convened with 28 members. The panel comprised four lay representatives, eight community pharmacists, four ED doctors, four Emergency Nurse Practitioners, four GPs and four practice nurses, recruited from the four home countries (Scotland, England, Northern Ireland and Wales). The purpose of this panel was to assess a random sample of the anonymised consultations that had been assessed by the uni-disciplinary panels, to measure the extent of agreement with the categorisation regarding whether consultations were minor ailments, and could be treated in a community pharmacy. The multi-disciplinary panel provided a validation role for the results derived from the uni-disciplinary panels.
The results of this exercise were used to identify the four most frequently occurring minor ailments, which were then used in the next stage of the research programme, the Cohort Study. Scenarios were developed for each of the four minor ailments which would be used in the Simulated Patient Study (see later). The panel members undertook two consensus rounds to identify components that would be associated with the ‘basic’ and ‘good’ management of the conditions presented in these scenarios.
Cohort Study
A cohort study is ongoing (December 2012). The purpose of this study is to identify, recruit and follow-up patients who present in ED, general practice or community pharmacy, with one of the four minor ailments identified by the routine data collection and consensus processes. This component will evaluate different models of delivery of care which compare costs and patient outcomes, the effect of the pharmacy staff’s consultation and diagnostic performance in the management of selected minor ailments of patient outcomes, and, explore triggers to seeking care for minor ailments from pharmacies (or other service providers).
This study addresses the following research questions:
• How do the effectiveness and costs of different models of delivery of care for minor ailments compare?
• What factors influence a patient’s decision to seek care for a minor ailment from a community pharmacy?
• How does the consultation and diagnostic performance of the pharmacy staff member affect patient outcome for the management of minor ailments?
This study is being conducted in East Anglia and Grampian. The following settings have been recruited to this study for each geographical site: one ED, three general practices and five community pharmacies (Figure 1).
Patient recruitment has been completed from ED and general practices in Grampian. Just over 50% of the target number of patients has been recruited from Grampian community pharmacies to date. Patient recruitment is ongoing at the East Anglia sites. The results of this study will be available in summer 2013.
Simulated Patient Study
This component will evaluate pharmacy staff’s consultation and diagnostic skills and addresses the following research question:
- How do pharmacy staff perform in terms of consultation and diagnostic behaviour during patient consultations for minor ailments?
A study will be conducted that will use simulated patient (SP) (also known as mystery shoppers) methods to assess pharmacy staff members’ consultation and diagnostic performance.
Eighteen community pharmacies from Grampian and East Anglia will be recruited to participate in this study (i.e. nine per site). The community pharmacies will be recruited to reflect different types (independent single outlets, small/large chains) and geographical locations (rural/urban). Simulated patients will be trained to deliver a minor ailment scenario during each visit to the nine pharmacies which reflects one of the four minor ailments targeted in the cohort study. The SP will record their visits using a digital recorder and they will also complete a data collection form following each visit. The results of the study will be derived from the recordings and from the information provided from the data collection forms. Each visit will be assessed to determine whether it achieved basic and/or good levels of practice, with levels of practice being established by the multi-disciplinary consensus panel (mentioned above).
Outputs
Each research component will be written up and submitted for:
- publication in peer reviewed journals
- presentation at relevant national and international conferences
- publication in other manuscripts for specific audiences e.g. executive summaries for policy makers, etc.
Dr M C Watson
Centre of Academic Primary Care
University of Aberdeen
Polwarth Building
Foresterhill
Aberdeen
Scotland
AB25 2ZD
Tel: 00 44 1224 437258
Email: m.c.watson@abdn.ac.uk
This project has now been completed with a final report and executive summary for viewing.
