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BACKGROUND: Pediatric emergency department (PED) admissions have risen in recent years, a trend not justified by the severity of the pathologies presented. The aim of this study is to analyse factors related to the inappropriate use of pediatric emergency departments. METHODS: This is a systematic review reported in accordance with the PRISMA statement. We searched the PubMed, Web of Science and Science Direct databases, using keywords extracted from MeSH, and conducted a reverse search using Google Scholar and Open Grey, for the period January 2017 to August 2022. The quality of the papers was assessed using STROBE, CASPe, AMSTAR-2, GRADE, Levels Of Evidence and Grades Of Recommendation. RESULTS: A total of 20 studies were selected. Factors related to inappropriate use included the younger age of children, black caregivers, lower socioeconomic status, lower parental educational attainment, perceived urgent demand for care, parental emotions in response to their children's health problems, psychological distress, the ineffective exercise of the parental role, the advantages of the PED and the nature of health insurance. CONCLUSIONS AND IMPLICATIONS: The results illustrate the heterogeneous nature of the phenomenon under investigation. Gaining an understanding of the factors related to the inappropriate demand of PEDs, from the perspective of health professionals, can help in developing interventions to reduce unnecessary consultations and relieve pressure on these healthcare services.

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BACKGROUND: Sore throat is a common and self-limiting condition. There remains ambiguity in stratifying patients to immediate, delayed, or no antibiotic prescriptions. The National Institute for Health and Care Excellence (NICE) recommends two clinical prediction rules (CPRs), FeverPAIN and Centor, to guide decision making. AIM: To describe the diagnostic accuracy of CPRs in identifying streptococcal throat infections. DESIGN & SETTING: Adults presenting to UK primary care with sore throat, who did not require immediate antibiotics. METHOD: As part of the Treatment Options without Antibiotics for Sore Throat (TOAST) trial, 565 participants, aged ≥18 years, were recruited on day of presentation to general practice. Physicians could opt to give delayed prescriptions. CPR scores were not part of the trial protocol but were calculated post hoc from baseline assessments. Diagnostic accuracy was calculated by comparing scores with throat swab cultures. RESULTS: It was found that 81/502 (16.1%) patients had group A, C, or G streptococcus cultured on throat swab. Overall diagnostic accuracy of both CPRs was poor: area under receiver operating characteristics (ROC) curve 0.62 for Centor; and 0.59 for FeverPAIN. Post-test probability of a positive or negative test was 27.3% (95% confidence interval [CI] = 6.0% to 61.0%) and 84.1% (95% CI = 80.6% to 87.2%) for FeverPAIN ≥4; versus 25.7% (95% CI = 16.2% to 37.2%) and 85.5% (95% CI = 81.8% to 88.7%) for Centor ≥3. Higher CPR scores were associated with increased delayed antibiotic prescriptions (χ2 = 8.42, P = 0.004 for FeverPAIN ≥4; χ2 = 32.0, P<0.001 for Centor ≥3). CONCLUSION: In those who do not require immediate antibiotics in primary care, neither CPR provides a reliable way of diagnosing streptococcal throat infection. However, clinicians were more likely to give delayed prescriptions to those with higher scores.

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BACKGROUND: The Pharmacy Minor Ailment Service (PMAS) was introduced in the UK over 15 years ago for use in treating minor ailments and has been shown to be effective and acceptable by the public in reducing the burden on high-cost healthcare settings (such as general practice and emergency departments). This paper aims to review the use of a PMAS in the paediatric population. METHODS: PMAS was established in a London Borough in 2013. Data were collected from 33 pharmacists and 38 GPs on demographics, service utilization and costs. RESULTS: In total, 6974 face-to-face consultations by 4174 patients were provided by pharmacies as part of the PMAS over a 12-month period. Moreover, 57% of patients were children with fever, hay fever and sore throat, accounting for 58% of consultations. Only 2% were signposted to other services. Sixty-nine percent of patients reported being seen within 5 min and 96% of patients were seen within 10 min with high levels of satisfaction. Cost savings of over GBP 192,000 were made during the scheme. CONCLUSIONS: PMAS is a highly cost effective, accessible and acceptable service for children with minor illnesses.

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To date, eight of ten Canadian provinces have authorized pharmacists to prescribe for minor ailments. Prompted by a request by the Ontario Minister of Health, draft regulations were submitted to enable this pharmacy service in Ontario. Differences exist in how jurisdictions have approached development and delivery of these programs. This paper will summarize key differences and similarities among existing programs while highlighting the multi-pronged approach utilized by Ontario. Such an approach involved broad stakeholder engagement, implementation science, and an evaluations framework to guide an assessment of the impact of this new service. These insights can be leveraged by other jurisdictions planning to initiate or evolve their minor ailment prescribing services.

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The delivery of healthcare in most developed countries is under increasing pressure. Ageing populations with increasingly complex needs, coupled with financial constraints and imbalances in workforce, mean that healthcare policies look to contain cost and utilise resource as effectively as possible. Self-care is now widely advocated as a mechanism to manage acute presentations with pharmacy identified as a key resource to support such policy. Pharmacy teams are ideally positioned to facilitate the management of patients who present with acute illness. However, current evidence suggests that patient assessment and establishing a differential diagnosis could be better. It appears that how pharmacists are taught at Schools of Pharmacy adopts a protocol driven approach, which assumes presentation of low acuity conditions, and we argue that this method must be replaced with a curriculum that adopts clinical reasoning. This paper sets out the process of clinical reasoning and how the profession could embrace this as a better model in establishing a diagnosis.

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Although Taiwanese citizens benefit from affordable health care, residents in remote areas extensively rely on unsafe self-care practices because of a lack of easy access to medical services. To improve self-care safety, ten easy-access self-care medical spots (ESCMSs) managed by trained residents were established in two remote villages. This study aimed to assess the impact of ESCMSs on self-care and access to medical services. For a total of six commonly experienced minor illnesses, the average number of illnesses for which residents were confident to perform self-care increased from 2.78 in the pretest to 3.58 in the post-test. ESCMSs were also the first choice when experiencing minor illnesses for 31.25% residents who did not visit a doctor. Residents' personal experience with ESCMSs correlated with their perception of ESCMSs' function. Compared with residents who had no personal experience of using ESCMSs, those who used the ESCMS service were less likely to store medications for minor illnesses at home (51.02% vs. 76.67%). Furthermore, those who attribute the reduced needs for professional help to ESCMSs had used medications for minor illnesses at ESCMSs. These results suggest that establishing ESCMSs is a viable alternative to increase the self-care capacity of residents in remote areas and increase the access to medical resources. Moreover, because residents are less likely to store medication and travel for professional help, ESCMSs could indirectly reduce the risks of self-medication and traffic accidents, respectively. However, caution should be exercised when generalizing these results to more populated areas that also lack medical resources.

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Background Increasing role of community pharmacists sometimes demands the diagnoses of minor ailments using appropriate questioning skills and recommendation of over-the-counter medications to patients seeking self-care. Objective To evaluate community pharmacists' questioning and diagnostic skills of minor ailment complaints, and the appropriateness of medication(s) recommendations made. Setting One hundred and thirty-one community pharmacies in Ibadan, Nigeria. Method A cross-sectional survey employing pseudo-patient study method. The pseudo-patient visited 131 community pharmacies from June 2017 to January 2018 and complained of stomach ache. The conversation between the pharmacists and pseudo-patient were audio-taped and transcribed verbatim. Two criteria were used to evaluate the questioning skill of the community pharmacists. One of the criteria was developed by a six-membered panel and had 13 questions while the other contained five questions:-Who is it for? What are the symptoms? How long have the symptoms been present? Action taken? and Medication used.? Questioning skill of the community pharmacists was classified based on the median scores of these two criteria as: poor, moderate and optimal. The diagnoses made by the community pharmacists from the pseudo-patients complaints were compared with the expected diagnosis of uncomplicated gastric ulcer caused by the use of ibuprofen. Recommendations for the pseudo-patients minor ailment were also compared with the Nigeria standard treatment guideline. Main outcome measure Pharmacists' questioning skill, types of diagnosis made and appropriateness of medications recommended. Results The median scores for the questioning skill criterion containing 5 and 13 questions were 2 and 4, respectively; showing poor questioning skill. Differential diagnoses of gastric ulcer, dyspepsia, gastroesophageal reflux, and hyperacidity were made by 92 (67.4%) pharmacists but 3 (2.3%) correctly diagnosed the pseudo-patients' minor ailment as uncomplicated gastric ulcer caused by short-term use of ibuprofen. Antacids were recommended in line with the standard treatment guideline by 46 (35.7%) pharmacists while proton pump inhibitors were recommended by 6 (4.7%) pharmacists. None advised the withdrawal of the provocative factor according to the treatment guideline. Conclusion The questioning skill of the community pharmacists in this setting was poor. Few community pharmacists diagnosed the pseudo-patients' minor ailment correctly. Also, recommendations were mostly inappropriate compared with the standard treatment guideline.

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OBJECTIVE: Non-urgent paediatric ED (PED) visits appear to contribute a large portion to the growing use of EDs globally. Several interventions have tried to curb repeated non-urgent attendances, but no systematic review of their effectiveness exists. This review examines the effectiveness of interventions designed to reduce subsequent non-urgent PED visits after a non-urgent attendance. METHOD: A systematic review design. A systematic search of four databases and key journals was conducted from their inception to November 2018. Experimental studies, involving children aged 0-18 years presenting to an ED for non-urgent care, which assessed the effectiveness of interventions on subsequent non-urgent attendance were considered. RESULTS: 2120 studies were identified. Six studies, including four randomised controlled trials (RCTs) and two quasi-experimental, were included. Studies were of moderate quality methodologically. All studies originated from the USA and involved informational and/or follow-up support interventions. Only two RCTs demonstrated the longest duration of intervention effects on reducing subsequent non-urgent PED attendance. These studies identified participants retrospectively after ED evaluation. The RCT with the largest number of participants involved follow-up support by primary physicians. Meta-analysis was impractical due to wide heterogeneity of the interventions. CONCLUSIONS: There is inconclusive evidence to support any intervention aimed at reducing subsequent non-urgent PED visits following a non-urgent attendance. The long-term impact of interventions is limited, although the effect may be maximised if delivered by primary care providers in children identified after their ED attendance. However, further research is required to evaluate the impact of any such strategies in settings outside the USA.

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AIMS AND OBJECTIVES: This study describes people's need for reassurance in self-care of minor illnesses. BACKGROUND: Self-care and active surveillance are advocated as important strategies to manage minor illnesses. Reassurance influences patient satisfaction and confidence in the practicing of self-care. DESIGN: This study is a descriptive and interpretive qualitative study. METHODS: Twelve persons with experience in self-care and receiving self-care advice were recruited, and data were collected using semi-structured interviews between September-December 2014. Data were analysed using qualitative content analyses. RESULTS: Having previous experience and the ability to actively manage symptoms using self-care interventions was described as reassuring. Participants became stressed and concerned when the symptoms persisted and interventions lacked the desired effect, which often resulted in a decision to consult. Participants wanted to feel that the nurse was an actual person, who was sympathetic, present and understanding, when they received self-care advice. The nurse's assessment and reasoning of the symptoms facilitated care-seekers' assessments of risk, and clear and concrete advice on how to manage the symptoms exerted a calming effect. Patients needed to trust that the nurse understood their situation to embrace the advice, and being invited to return created a feeling that the nurse had listened and taken them seriously. CONCLUSIONS: Reassurance has the potential to allay doubts and fears to build confidence, which influences self-care and consultation behaviour. Personal presence in the encounter, receiving an assessment and an explanation of the symptoms and precise advice are reassuring. RELEVANCE TO CLINICAL PRACTICE: The needs of nursing care may persist despite the absence of medical needs. The encounter between the nurse and care-seeker is a unique possibility for reassurance and confidence that a minor illness is self-limiting in its nature, and self-care interventions provide relief and comfort.

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INTRODUCTION: Over 5 million children attend the Emergency Department (ED) annually in England with an ever-increasing paediatric emergency caseload echoed globally. Approximately 60% of children present with illness and the majority have non-urgent illness creating burgeoning pressures on children's ED and this crisis resonates globally. To date no qualitative systematic review exists that focuses on the parental reasons for childhood attendance at the ED in this sub-group. AIM: To identify parental reasons for attending ED for their children presenting with minor illness. METHOD: A qualitative systematic review was conducted against inclusion/exclusion criteria. Five electronic databases and key journals were searched in June 2015. FINDINGS: 471 studies were identified and following study selection, 4 qualitative studies were included. Nine themes were identified e.g. dissatisfaction with family medical services, perceived advantages of ED and 'child suffering' with novel and insightful sub-themes of 'hereditary anxiety', 'taking it off our hands', ED as a 'magical place'. CONCLUSION: This novel qualitative systematic review examined parental attendance presenting with childhood minor illness of interest to emergency care reformers and clinicians. ED attendance is complex and multifactorial but parents provide vital insight to ED reformers on parental reasons for ED attendance in this sub-group.

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AIM: The aim of this study is to explore the influence of nurse-led self-care advice on healthcare utilization and patients' satisfaction with telephone nursing. BACKGROUND: Many consultations in high-cost settings are for conditions that are manageable through self-care and callers with greater satisfaction with the nurse interaction are nearly four times more likely to engage in self-care. DESIGN: Cross-sectional study. METHODS: Questionnaires were sent out to 500 randomly selected callers to the Swedish Healthcare Direct in Northern Sweden during March 2014. Callers were asked about their satisfaction with the consultation, their intended actions prior to consultation, the recommendation given by the nurse and the action undertaken after the call. RESULTS: Young callers and persons recommended watchful waiting or recurrence if no improvements were significantly less satisfied with their care. When calling on their own behalf, both men and women rated the severity of their symptoms equally and were advised to self-care to the same extent. Self-care advice had a constricting influence on self-reported healthcare utilization, with 66·1% of cases resulting in a lower level of care than first intended. Feeling reassured after the call was the aspect of nursing care that influenced satisfaction the most. CONCLUSION: Receiving self-care advice rather than referral to a general practitioner influences patient satisfaction negatively. Feeling reassured after consultation is strongly related to satisfaction, which in turn has been found to increase the likelihood of engaging in self-care behaviour.

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INTRODUCTION: Attention to patients with acute minor illnesses represents a major burden for primary care. Although programs of nurse care for children with acute minor illnesses in primary care started a long time ago, there is limited information about the results of these programs in current practice. OBJECTIVES: The objective of this study was to assess the feasibility and efficacy of a program of nurse management for unscheduled consultations of children with acute minor illnesses. METHODS: Observational study of children seeking unscheduled consultations for 16 acute minor illnesses in 284 primary care practices during a 2-year period. The program of nurse management used predefined management algorithms. FINDINGS: Among 467,160 consultations performed, case resolution was achieved in 65.4%. The remaining 34.6% of cases were not solved by the primary healthcare nurse due to the existence of signs of alarm and were referred to a pediatrician. Return to consultation during a 7-day period for the same reason as the original consultation was only 2.6%. CONCLUSIONS: A program that uses management algorithms is effective for nurse care management of children with acute minor illnesses in primary care. CLINICAL RELEVANCE: Application of programs of nurse management for unscheduled consultations for children with acute minor illnesses is feasible and effective.

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Reliable and valid instruments are essential when examining the role of self-efficacy and locus of control in the self-care context. The aim of this study was to test the validity and reliability of the Self-Efficacy Scale in Self-Care (SESSC) and the Swedish version of the Recovery Locus of Control scale (RLoC) in the context of minor illness. A descriptive correlational design was used to assess the psychometric characteristics of the scales. The study population was 317 randomly selected Swedish inhabitants aged 18-80. The results from this study showed that the RLoC has limitations in reliability and validity and should not be applied in the context of self-care of minor illness. The SESSC proved to be a reliable and valid instrument in assessing self-efficacy in self-care for minor illness.

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Official classification for low birth weight is 2500 gram or below. Whilst there is no consensus of what constitutes normal birth weight, it has been suggested that the optimal birthweight for long term health is 3500 - 4500 gram; hence those with birth weight between 2500 and 3490 gram could be deemed to be a sub clinical population. The objective was to investigate the relationship between disease and birthweight and to compare vulnerability of those with suboptimal and optimal birthweight in adulthood. This is a cohort study; with cross sectional retrospective design involving 258 adults aged 18-62 who knew their birth weight. Participants completed a minor illness checklist, using a median split, participants were categorised as high or low minor illness group. Results indicate a negative correlation between birthweight and minor illness score (r = -.155, p = .013). Those born with sub optimal birthweight are more likely to report minor illness symptoms above the media score of 16 (OR 1.70 CI 95 percent 1.04-2.79).It is concluded that there is a relationship between birthweight and level of minor illness in adulthood. Those born with birthweight 2500 - 3490 gram appear to be more vulnerable to minor illness. Thus, working with Foetal Origins theory, it may be possible that this group experienced a degree of foetal compensation, the consequence being that the immune system is compromised. Application of a three dimensional equilibrium model is suggested in designing interventions that improve foetal environment and subsequent health chances.(AU)

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This article presents a review, based on a qualitative study, of pharmaceutical orientation in the management of minor illness. Action research methodology was used by a group of faculty members responsible for the community pharmacy internship and by postgraduates in clinical pharmacy, to carry out the study with the objective to present a standard service for this kind of procedure. The interaction with the individual starts with a welcoming reception, at which point the pharmacist should be receptive and show empathy. Subsequently, data from the history of the patient are collected to obtain relevant information. Based on this information, the pharmacist must develop a line of clinical reasoning and make a decision, taking the context of the patient into account. After this analysis, the most appropriate intervention is performed. This intervention could indicate the need for referral to another health professional, the use of a non-pharmacological therapy or the provision of sound advice on medicines available without prescription. The next step is monitoring the patient in order to identify the effectiveness and safety of treatment. The standardization process of pharmaceutical attendance in the management of minor disorders contributes to the rational use of medicines.

A reflexão apresentada neste artigo representa um estudo de abordagem qualitativa baseada na pesquisa-ação da prática do atendimento farmacêutico no manejo de transtornos menores, realizada pelo grupo de professores do Estágio em Farmácia Comunitária e por farmacêuticos pós-graduados em Farmácia Clínica, com o objetivo de realizar uma proposta de atendimento padrão para este tipo de procedimento. A interação com o indivíduo é iniciada pelo acolhimento, momento no qual o farmacêutico deve ser receptivo e empático. A seguir, se executa a coleta de dados sobre a história do paciente, para obtenção de informações relevantes. Com base nas informações, o farmacêutico deve desenvolver um raciocínio clínico e tomar uma decisão, levando em consideração o contexto do paciente. Após esta análise é realizada a intervenção mais adequada ou o conjunto dessas que podem ser: procurar outro profissional de saúde, utilizar uma terapia não-farmacológica ou auxiliar na escolha de um medicamento de venda livre. O próximo passo é o acompanhamento do paciente com vistas a identificar a efetividade e segurança do tratamento. A padronização do processo de atendimento farmacêutico no manejo de transtornos menores, contribui para o uso racional de medicamentos.

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Objetivo Analizar las evidencias de validez y fiabilidad de un cuestionario de satisfacción de pacientes con el servicio de indicación en las farmacias comunitarias argentinas. Material y Métodos Estudio descriptivo de corte transversal. Participaron todos los pacientes o sus cuidadores que concurrieron a las farmacias durante el período de estudio (marzo y abril de 2006) y que supieran leer y escribir. Resultados Se obtuvieron 289 cuestionarios. El análisis factorial reveló un único componente explicando el 52,2 por ciento de la varianza total. Se obtuvo un coeficiente alfa de Cronbach de 0,89. Los pacientes expresaron comentarios adicionales en 87 cuestionarios (30,1 por ciento) que se relacionaron con la calidad de la atención recibida y con otros aspectos de la asistencia. Discusión El cuestionario mostró evidencias de validez de contenido, validez como estructura interna y fiabilidad para valorar la satisfacción de pacientes con el servicio de indicación en las farmacias comunitarias argentinas.

Objective Analysing the evidence regarding the validity and reliability of a patient-satisfaction questionnaire about professional advice received for minor illness in Argentinean community pharmacies. Methods This was a descriptive, cross-sectional study. All patients or their caregivers who visited the pharmacies during the study period (March and April, 2006) and knew how to read and write were included. Results 289 questionnaires were completed. Factorial analysis revealed one single component explaining 52.2 percent of total variance. A 0.89 Cronbach's alpha coefficient was obtained. Patients made additional comments on 87 questionnaires (30.1 percent) concerning the quality of care received and other aspects. Discussion By presenting evidence of content validity, validity as internal structure and reliability the questionnaire could assess patient-satisfaction with the advice received for minor illness in Argentinean community pharmacies.

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