Adding to the complexity of this literature, Attree et al. (46) found that despite achieving benefits in physical health, CE may result in unintended negative consequences such as exhaustion, financial burden, consultation fatigue, and disappointment for some participants, who were repeatedly exposed to successive waves of CE, which adversely affected their health.
No information was available concerning patients' pre-treatment symptom burden or consultations, which may have influenced patients' satisfaction.
Infectious intestinal disease (IID) is a common cause of illness in the community and results in a high burden of consultations to general practice (GP).
The authors mitigate reporting by probing each patient with these symptoms; this yields a more complete analysis although does impart a small time burden during the consultation.
Presumably, many of the respiratory problem and fever cases that presented at pharmacies were not perceived as severe and could be managed at home, a distinction which is important for both refugees in terms of reduced out-of-pocket payments and the health system because of the lower consultation burden when minor illnesses are managed at home.
Most GPs stated that both tympanometry and pneumatic otoscopy could assist in diagnosis of OM without creating an undue time burden within the consultation, however, this did not translate into a strong intention to use the techniques in the future.
When GPs considered the time issue, they were more concerned that IPV screening/routine inquiry would be too large a burden on the consultation and that this screening was not related to their competencies.
For each patient contact, the GP was asked to fill in a one-page registration form covering a range of questions, e.g. on chronic disease, reason for encounter, new episode or follow-up, diagnosis, perceived burden of the consultation, referral to specialist care, suspicion of serious disease and whether a nurse could have substituted the GP.
While the burden of additional consultations appears manageable at primary care level, a significantly higher demand for specialist care poses significant challenges to the health system.
