Our study provided an opportunity to better understand the adult patient or parent who seeks care particularly early in the course of the illness. Our research question was: Are those patients or parents who make contact with their care providers particularly early in the course of the illness different from those who make contact later in any way that should affect the way in which they are approached by clinicians or nurses? We hypothesized that the illnesses of these patients are different or that they have different reasons for seeking care from those who present later in the course of the illness. We felt that if clinicians understood these differences, perhaps they could help these patients more effectively, and care systems could reduce unnecessary services and antibiotic usage.
Methods
To test these hypotheses we conducted a telephone survey of cross-sectional samples of adults or parents of children seeking care for URI symptoms at one of 3 diverse primary care clinics in the Minneapolis/St. Paul region of Minnesota: a primary care site for a large multispecialty group practice in an affluent suburb, a staff-model health maintenance organization clinic in a blue-collar suburb, and a medium-sized primary care medical group in a nearby town.
To be included in the sample, adults had to be from 18 to 64 years old or parents of children aged 3 months to 17 years. The patients needed to have a runny nose, cough, or sore throat and to have called or visited the clinic within 14 days (adults) or 10 days (parents) of the onset of symptoms during the study period (March 1, 1997, to May 1, 1997). The subjects were excluded if they reported poor general health, ear pain or infection, or did not speak English. Eligible people were identified from each clinic’s logs of walk-in visits, scheduled appointments, or calls to get advice.
A telephone interview was conducted between 48 and 96 hours after the initial contact with the clinic. Patient selection continued until at least 80 adults and 80 parents of children had participated from each site. The interview consisted of 88 questions devised by study investigators and revised after interviews with 20 patients. Additional pretesting was done with the first 15 patients identified in one clinic. A second 15-item follow-up interview was conducted with the subset of participants who had initially made contact with the clinic within 7 days (adults) or 5 days (parents) of the onset of symptoms. This follow-up interview was made on day 14 (adults) or day 10 (parents) of symptom onset to assess the episode of illness more completely.
Because the dependent variable of interest was the number of days between the onset of illness and the patient’s contact with the clinic, subjects were divided into 3 approximately equal groups. Because contact in the first 2 days of illness may be the most difficult for clinicians to understand and because McIsaac and coworkers16 showed that adults with URI symptoms for more than 2 days were 2.7 times more likely to visit the physician than those sick for 1 to 2 days, the members of this group were designated as the early callers. These callers were compared with those who waited to contact their clinic until between 3 and 5 days or after 5 days of symptoms (who constitute the other 2 groups). Because nearly all subjects had made both a call and a visit (usually within a very short period of time), it was not possible to clearly separate the response into these 2 groups in the analysis.
Descriptive statistics were examined separately for each of the study variables for adult patients and parents. We used the chi-square test of association to compare categorical variables for the 3 illness duration subgroups within each age group.
Results
Interviews were completed with 257 adult patients and 249 parents of child patients (with completion rates of those who met the selection criteria of 94% and 90%, respectively). The sample size for each subgroup by duration of illness and the demographic characteristics of these individuals are listed in Table 1.
Twenty-eight percent of the adult patients and 41% of the child patients had been ill only 1 to 2 days at the time of their first contact with the health care system. None of the characteristics listed in Table 1 differed significantly among these groups, except that parents calling within 2 days of their child’s illness were somewhat less likely to have a college education than parents calling later.
Table 2 illustrates that early callers (in the first 2 days) did not have symptoms that were more frequent or severe than the other groups. In fact, children in this group were less likely to have a cough or green nasal drainage than those in the groups that made contact later (after 3 or more days). Fever, however, was less frequent in both adults and children of parents who sought care after 5 days.