Symptomatic Management of Fever in Children: A National Survey of Healthcare Professionals’ Practices in France

Abstract

Despite the production and dissemination of recommendations related to managing fever in children, this symptom saturates the practices of primary healthcare professionals (HPs). Data on parent practices related to fever are available, but data on HPs’ practices are limited. We studied HPs’ practices, determinants of practices and concordance with recommendations in France. We conducted a national cross-sectional observational study between 2007 and 2008 among French general practitioners, primary care pediatricians and pharmacists. HPs were asked to include 5 consecutive patients aged 1 month to 12 years with acute fever. HPs completed a questionnaire about their practices for the current fever episode. We used a multilevel logistic regression model to assess the joint effects of patient- and HP-level variables associated with this behavior. In all, 1,534 HPs (participation rate 13%) included 6,596 children (mean age 3.7 ± 2.7 years). Physicians measured the temperature of 40% of children. Primary HPs recommended drug treatment for 84% of children (including monotherapy for 92%) and physical treatment for 62% (including all recommended physical treatments for 7%). HPs gave written advice or a pamphlet for 13% of children. Significant practice variations were associated with characteristics of the child (age, fever level and diagnosis) and HP (profession and experience). In France, despite the production and dissemination of national recommendations for managing fever in children, primary HPs’ observed practices differed greatly from current recommendations, which suggests potential targets for continuing medical education.

Knowledge, attitudes and misconceptions of Italian healthcare professionals regarding fever management in children

“…Italian pediatricians’ knowledge seems to be in line, or slightly better, than those reported in other European countries in recent years. As an example, the use of physical methods was recommended by 77% of paediatricians in Switzerland [ 8 ] and 74% of them [ 9 ] in France; this proportion is higher than observed in our study (about 50%). Alternate use of antipyretics was recommended by 65% of Swiss paediatricians [ 8 ] but only by 11% of our participants.…”

National cross‐sectional study of nonsteroidal anti‐inflammatory drugs use highlights differences between parents and professionals and prompts safety concerns

“…The study, the instrument and data collection process have previously been described in detail . In summary, we performed an observational, national study over eight months from November 2007 to June 2008.…”

“…When it came to patients recruited by the pharmacists, and in line with current practice, no data were collected on the temperature measurement during the contact with the healthcare professional or on the final medical diagnosis. As reported elsewhere, the mean participation rate of healthcare professionals was 13% . The sample included 6596 children recruited by 757 GPs, 373 paediatricians and 404 pharmacists.…”

“…Ninety‐one per cent of the parents administered a drug to their child for the symptomatic treatment of the current episode before the first contact with the healthcare professional . An antipyretic or analgesic medicine was prescribed by physicians for 96% of the patients and was recommended by pharmacists for 52% of the patients .…”

Hypersensitivity to antipyretics: pathogenesis, diagnosis, and management

“…Paracetamol was the firstchoice AP among 88% of health care professionals while ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), was preferred by 11%. 2 Diclofenac sodium and mefenamic acid have also been advocated as APs for children. 3,4 What makes use of APs truly ubiquitous is their non-prescription, overthe-counter availability.…”