This suggests that interventions should include strategies to limit the costs incurred during the first inappropriate consultation.
In a previous study in Nigeria, 67% of patients receiving treatment for tuberculosis had earlier consulted chemists and traditional healers, transaction costs accounted for 24% of the costs of care, and 62% of transaction costs were incurred during the first inappropriate consultation [7].
In addition, frequent attendance may be a sign of inappropriate consultation behaviour [ 8- 11].
General practitioners mentioned their lack of familiarity with this type of service as a cause of inappropriate consultation strategies, which could result in untimely referrals.
As a result it may have been inappropriate to consider consultations with the wider primary care team for low impact symptoms as incongruous consultation behaviour.
In Nepal, over-the-counter availability, dispensing of antimicrobials without professional consultation, inappropriate usage and the use of antimicrobials with low potency as a result of poor manufacturing and storage conditions or counterfeiting are common, and encourage AMR development [ 3, 4].
Some of the limitations included lack of space for private consultations, and inappropriate facilities for bare weighing babies.
More than 50% of the consultations were deemed inappropriate.
In Spain, around 30% of ED consultations are deemed inappropriate, and while some ED have attempted to improve efficiency by redesigning circuits, most of the resulting benefits are lost after a few years [ 2].
