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Observational Study
. 2015 May 19;5(5):e007365.
doi: 10.1136/bmjopen-2014-007365.

Workload and management of childhood fever at general practice out-of-hours care: an observational cohort study

Eefje G P M de Bont  1 , Julie M M Lepot  1 , Dagmar A S Hendrix  1 , Nicole Loonen  1 , Yvonne Guldemond-Hecker  2 , Geert-Jan Dinant  1 , Jochen W L Cals  1
Affiliations
Observational Study

Workload and management of childhood fever at general practice out-of-hours care: an observational cohort study

Eefje G P M de Bont et al. BMJ Open. .

Abstract

Objective: Even though childhood fever is mostly self-limiting, children with fever constitute a considerable workload in primary care. Little is known about the number of contacts and management during general practitioners' (GPs) out-of-hours care. We investigated all fever related telephone contacts, consultations, antibiotic prescriptions and paediatric referrals of children during GP out-of-hours care within 1 year.

Design: Observational cohort study.

Setting and patients: We performed an observational cohort study at a large Dutch GP out-of-hours service. Children (<12 years) whose parents contacted the GP out-of-hours service for a fever related illness in 2012 were included.

Main outcome measures: Number of contacts and consultations, antibiotic prescription rates and paediatric referral rates.

Results: We observed an average of 14.6 fever related contacts for children per day at GP out-of-hours services, with peaks during winter months. Of 17,170 contacts in 2012, 5343 (31.1%) were fever related and 70.0% resulted in a GP consultation. One in four consultations resulted in an antibiotic prescription. Prescriptions increased by age and referrals to secondary care decreased by age (p<0.001). The majority of parents (89.5%) contacted the out-of-hours service only once during a fever episode (89.5%) and 7.6% of children were referred to secondary care.

Conclusions: This study shows that childhood fever does account for a large workload at GP out-of-hours services. One in three contacts is fever related and 70% of those febrile children are called in to be assessed by a GP. One in four consultations for childhood fever results in antibiotic prescribing and most consultations are managed in primary care without referral.

Keywords: PRIMARY CARE; PUBLIC HEALTH.

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Figures

Figure 1
Figure 1
Flow chart of all children <12 years contacting the general practitioner out-of-hours service.
Figure 2
Figure 2
Daily distribution per month of contacts of febrile children <12 years in 2012.
See this image and copyright information in PMC

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