Abstract
BackgroundMinor ailments are “self-limiting conditions which may be diagnosed and managed without a medical intervention”. A cluster randomised controlled trial (cRCT) was designed to evaluate the clinical, humanistic and economic outcomes of a Minor Ailment Service (MAS) in community pharmacy (CP) compared with usual care (UC).MethodsThe cRCT was conducted for 6 months from December 2017. The pharmacist-patient intervention consisted of a standardised face-to-face consultation on a web-based program using co-developed protocols, pharmacists’ training, practice change facilitators and patients’ educational material. Patients requesting a non-prescription medication (direct product request) or presenting minor ailments received MAS or UC and were followed-up by telephone 10-days after the consultation.The primary economic outcomes were incremental cost-utility ratio (ICUR) of the service and health related quality of life (HRQoL). Total costs included health system, CPs and patient direct costs: health professionals’ consultation time, medication costs, pharmacists’ training costs, investment of the pharmacy and consultation costs within the 10 days following the initial consultation. The HRQoL was obtained using the EuroQoL 5D-5L at the time of the consultation and at 10-days follow up. A sensitivity analysis was carried out using bootstrapping. There were two sub-group analyses undertaken, for symptom presentation and direct product requests, to evaluate possible differences.ResultsA total of 808 patients (323 MAS and 485 UC) were recruited in 27 CPs with 42 pharmacists (20 MAS and 22 UC). 64.7% (n = 523) of patients responded to follow-up after their consultation in CP. MAS patients gained an additional 0.0003 QALYs (p = 0.053). When considering only MAS patients presenting with symptoms, the ICUR was 24,733€/QALY with a 47.4% probability of cost-effectiveness (willingness to pay of 25,000€/QALY). Although when considering patients presenting for a direct product request, MAS was the dominant strategy with a 93.69% probability of cost-effectiveness.ConclusionsExpanding community pharmacists’ scope through MAS may benefit health systems. To be fully cost effective, MAS should not only include consultations arising from symptom presentation but also include an oversight of self-selected products by patients. MAS increase patient safety through the appropriate use of non-prescription medication and through the direct referral of patients to GP.Trial registrationISRCTN, ISRCTN17235323. Registered 07/05/2021 - Retrospectively registered
Highlights
Minor ailments are “self-limiting conditions which may be diagnosed and managed without a medical intervention”
To be fully cost effective, Minor Ailment Service (MAS) should include consultations arising from symptom presentation and include an oversight of self-selected products by patients
A total of 808 patients (13 MAS and 14 usual care (UC)) were recruited in 27 community pharmacy (CP) with 42 pharmacists (20 MAS and 22 UC)
Summary
Minor ailments are “self-limiting conditions which may be diagnosed and managed without a medical intervention”. Minor ailments are defined as “common or self-limiting conditions which may be diagnosed and managed without a medical (i.e. doctor) intervention” [2]. Minor ailment services (MASs) have been implemented in CPs in a number of countries as part of governments’ health policies [5,6,7,8,9,10]. Studies have estimated that the percentage of GP visits due to minor ailments vary between 18 to 31.2% [13, 14], with 13.2% potentially manageable by CPs [15]. A study carried out in North East England estimated that up to 8% [15] of ED workload is for minor ailment presentations that could potentially be managed in CP
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