Preschool children in Danish out-of-hours primary care: a one-year descriptive study of face-to-face consultations

Lous, Jørgen; Moth, Grete; Huibers, Linda; Vedsted, Peter; Christensen, Morten Bondo

doi:10.1186/s12875-019-0922-y

Cited by 7 publications

(5 citation statements)

References 26 publications

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“…This finding is in line with those of Lous et al. (2019), who found that 41% of children aged 0–5 received an respiratory tract infection diagnosis in an out-of-office setting and 12% was diagnosed with acute otitis media, for which 70% received an antibiotic prescription, despite the proven lack of effect [ 6 , 33 ]. In relation to our results, this raises the question if part of the decline in antibiotic prescriptions in general practice is due to this increased use of out-of-hour care described by Lous et al.…”

Section: Discussionsupporting

confidence: 90%

Trend in antibiotic prescription to children aged 0–6 years old in the capital region of Denmark between 2009 and 2018: Differences between municipalities and association with socioeconomic composition

Larsen

Jensen

Bjerrum

et al. 2021

European Journal of General Practice

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Background To curb future antibiotic resistance it is important to monitor and investigate current prescription patterns of antibiotics. Objectives To examine trends in antibiotic prescription to children aged 0–6 years old and the association with socioeconomic status of municipalities in the Capital region of Denmark between 2009 and 2018. Methods This is a register-based study combining data on antibiotic treatments from 2009 to 2018, inhabitant-data and socioeconomic municipality scores. Subjects were children aged 0–6 years, residing in the Capital Region of Denmark. The study quantifies the use of antibiotics as number of antibiotic treatments/1000 inhabitants/year (TIY), inhabitants defined as children aged 0–6. Socioeconomic status of the municipalities is evaluated by a score from 3 to 12. Results The average TIY of the municipalities decreased from 741.2 [95%CI 689.3–793.2] in 2009 to 348.9 [329.4–368.4] in 2018. The difference between the highest and lowest prescribing municipalities was reduced from 648.3 TIY in 2009–212.5 TIY in 2018. The average increase in TIY per unit increase in socioeconomic municipality score changed from 20.05 [7.69–31.06] in 2009 to −4.58 [-16.02–5.60] in 2018, representing a decreasing association between socioeconomic municipality score and use of antibiotic in the respective municipalities. Conclusion The trend in antibiotic prescription to children aged 0–6 years old decreased substantially in all the investigated municipalities in the 10-year study period. Local differences in prescription rates declined towards a more uniform prescription pattern across municipalities and association with socioeconomic status of the municipalities was reduced.

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Section: Discussionsupporting

confidence: 90%

Trend in antibiotic prescription to children aged 0–6 years old in the capital region of Denmark between 2009 and 2018: Differences between municipalities and association with socioeconomic composition

Larsen

Jensen

Bjerrum

et al. 2021

European Journal of General Practice

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“…Pediatric calls are highly prevalent at OOH medical helplines [4,5] even though acutely ill children rarely are severely ill: only approximately 1% of children assessed acutely in general practices (GP) or pediatric emergency departments (PED) have a serious illness [6,7]. The majority of pediatric contacts in OOH care are related to infections, such as fever, symptoms from the upper respiratory tract, and ear infection [4,8,9]. The large number of OOH calls concerning children is most often caused by parental worry [10][11][12], but other motives for contact range from convenience and logistical reasons, to fear of doing the wrong thing and need for reassurance and sharing of responsibility [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

How parents express their worry in calls to a medical helpline: a mixed methods study

et al. 2022

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Background Telephone triage is used globally in out-of-hours primary care, to prioritize who needs urgent assessment. Even though children rarely are severely ill, calls about sick children are among the most prevalent, mainly due to parental worry. Pediatric calls are considered challenging, as the call-handler must rely on parents’ second-hand information. We aimed to investigate if parents’ worry can be used as a predictor of severe illness, and if the content of the calls varies between different grades of worry. Methods In a convergent mixed methods study design we asked patients to rate their degree-of-worry before talking to a call-handler. We used quantitative data of degree-of-worry, triage- and patient outcome in pediatric calls (n = 2857), and the qualitative content from 54 calls with subsequent hospitalization ≥24 h. Results High degree-of-worry was associated with hospitalization ≥24 h (OR 3.33, 95% CI 1.53–7.21). Qualitative findings both confirmed and expanded knowledge of degree-of-worry. Worry was the predominant cause for contact overall, and was mainly triggered by loss-of-control. In calls with high degree-of-worry, the prevalence of loss-of-control was especially high, and the parents had additionally often contacted healthcare services recently. Parents with a foreign accent often rated their worry as high, and these callers were often ignored or interrupted. Calls with low degree-of-worry seemed to occur early during the disease. Conclusion High degree of parental worry was associated with severe illness. At the end of calls, call-handlers should ensure that the parent has regained control of the situation to reach increased reassurance and to prevent renewed unnecessary contact. Safety-netting is crucial, as many parents made contact early during the illness and deterioration may develop later. The scoring of parental degree-of-worry may be used as an indicator of potentially severe illness and can easily be implemented at out-of-hours call-centers globally. Trial registration Original study registered at clinicaltrials.gov (NCT02979457).

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“…Use of the National Health Service (NHS) is high and rising [1,2]. Respiratory tract infection (RTI) is a common illness amongst children under the age of 12 [3] and is the most common paediatric presentation managed by primary care clinicians [4,5]. Most RTIs are self-limiting illnesses, albeit with longer courses than expected by both clinicians and parents [6][7][8], and are rarely serious enough to require hospital admission [9].…”

Section: Introductionmentioning

confidence: 99%

Predicting poor outcomes in children aged 1–12 with respiratory tract infections: A systematic review

et al. 2021

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Background Demand for NHS services is high and rising. In children respiratory tract infections (RTI) are the most common reason for consultation with primary care. Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. Aim To identify symptoms, signs, and investigation results associated with good and poor prognosis, and clinical decision making in children aged 1–12 years with RTI symptoms, at home and presenting to ambulatory care. Design and setting Systematic literature review. Methods We searched MEDLINE, EMBASE, Cinahl, Web of Science and the Cochrane database of systematic reviews for studies of children aged 1 to 12 years with a RTI or related condition reporting symptoms, signs and investigation results associated with prognostic outcomes. Quality was assessed using the QUIPS tool. Results We included 27 studies which included 34802 children and measured 192 factors. Nine studies explored future outcomes and the remainder explored clinical management from the initial consultation with the health services. None were conducted in a home setting. Respiratory signs, vomiting, fever, dehydration and tachycardia at the initial contact were associated with future hospitalisation. Little evidence was available for other outcomes. Conclusion Some evidence is available to clinicians to stratify risk of, future hospitalisation, but not of other prognostic outcomes. There is little evidence available to parents to identify children at risk of poor prognosis. Research is needed into whether poor prognosis can be predicted by parents in the home.

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Preschool children in Danish out-of-hours primary care: a one-year descriptive study of face-to-face consultations

Cited by 7 publications

References 26 publications

Trend in antibiotic prescription to children aged 0–6 years old in the capital region of Denmark between 2009 and 2018: Differences between municipalities and association with socioeconomic composition

Trend in antibiotic prescription to children aged 0–6 years old in the capital region of Denmark between 2009 and 2018: Differences between municipalities and association with socioeconomic composition

How parents express their worry in calls to a medical helpline: a mixed methods study

Predicting poor outcomes in children aged 1–12 with respiratory tract infections: A systematic review

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