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

Bont, Eefje de; Lepot, Julie M M; Hendrix, Dagmar A S; Loonen, Nicole; Guldemond-Hecker, Yvonne; Dinant, Geert-Jan; Cals, Jochen

doi:10.1136/bmjopen-2014-007365

Cited by 44 publications

(47 citation statements)

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“…4 We identified an average of 15 consultations per day for children with fever and fever-related conditions. On the basis of this cohort study and a pilot study, we assumed that 1,000 children per center could be included in the trial in 6 months.…”

Section: Discussionmentioning

confidence: 99%

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Booklet for Childhood Fever in Out-of-Hours Primary Care: A Cluster-Randomized Controlled Trial

et al. 2018

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PURPOSE Fever is the most common reason for a child to be taken to a physician, yet the level of unwarranted antibiotic prescribing remains high. We aimed to determine the effect on antibiotic prescribing of providing an illness-focused interactive booklet on fever in children to out-of-hours primary care clinicians. METHODSWe conducted a cluster-randomized controlled trial in 20 out-ofhours general practice centers in the Netherlands. Children aged younger than 12 years with fever were included. Family physicians at the 10 intervention sites had access to an illness-focused interactive booklet between November 2015 and June 2016. The primary outcome was antibiotic prescribing during the index consultation. Analysis was performed by fitting 2-level random intercept logistic regression models. RESULTSThe trial took place among 3,518 family physicians and 25,355 children. The booklet was used in 28.5% of 11,945 consultations in the intervention group. Compared with usual care, access to the booklet did not significantly alter antibiotic prescribing during the index consultation (odds ratio = 0.90; 95% CI, 0.79-1.02; prescription rate, 23.5% vs 25.2%; intracluster correlation coefficient = 0.005). In contrast, use of the booklet significantly reduced antibiotic prescribing (odds ratio = 0.83; 95% CI, 0.74-0.94; prescription rate, 21.9% vs 25.2%; intracluster correlation coefficient = 0.002). Children managed by family physicians with access to the booklet were less likely to receive any drug prescription, and parents in the booklet group showed a reduced intention to consult again for similar illnesses.CONCLUSIONS Benefit of an illness-focused interactive booklet in improving outcomes of childhood fever in out-of-hours primary care was largely restricted to the cases in which family physicians actually used the booklet. Insight into reasons for use and nonuse may inform future interventions of this type. Ann Fam Med 2018;16:314-321. https://doi.org/10.1370/afm.2265. INTRODUCTIONF ever is the most common reason for a child to be taken to a physician, and most fever consultations take place in general practice.1 As many parents work during the day and fever typically rises in the early evening, these rates are even higher during out-of-hours care.1,2 In most cases, fever is caused by benign viral infections, and general recommendations given by a family physician are sufficient for management. One in every 3 to 4 children who visit family physician out-of-hours care with a fever receives an antibiotic prescription, however. 4,5 These prescription rates are nearly twice as high as those during routine office hours. 6 Consultations are generally driven by parental concerns about harmful consequences of fever. These concerns can be more prominent when needing to consult a family physician on call who is not their personal family physician. 7Previous studies have shown that antibiotic prescribing is strongly influenced by patients' expectations and that family physicians experience pressure from patients to presc...

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Section: Discussionmentioning

confidence: 99%

“…3 One in every 3 to 4 children who visit family physician out-of-hours care with a fever receives an antibiotic prescription, however. 4,5 These prescription rates are nearly twice as high as those during routine office hours. 6 Consultations are generally driven by parental concerns about harmful consequences of fever.…”

Section: Introductionmentioning

confidence: 99%

Booklet for Childhood Fever in Out-of-Hours Primary Care: A Cluster-Randomized Controlled Trial

et al. 2018

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“…Of all GP-prescribed antibiotics, only 6% were prescribed OOH. Comparatively more amoxicillin and amoxicillin/ clavulanate were prescribed; amoxicillin, as children more often present at OOH, 23 and higher amoxicillin/clavulanate use was specifically seen for tonsillitis, cystitis, and impetigo (Table 2). Overall, OOH firstchoice prescribing was comparable with office hours prescribing.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prescribing during office hours and out-of-hours: a comparison of quality and quantity in primary care in the Netherlands

2017

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“…To inform the required sample size, we performed a retrospective cohort study to determine the number of children visiting a GP out-of-hours cooperative [4]. We identified 17,170 contacts for children younger than 12 years of age.…”

Section: Methodsmentioning

confidence: 99%

“…However, one in three to four children who visit a GP out-of-hours centre because of a fever receive an antibiotic prescription. Most often, this is unnecessary and not recommended in guidelines [4, 5]. Additionally, these prescription rates are nearly twice as high as prescription rates during routine office hours [6].…”

Section: Introductionmentioning

confidence: 99%

An illness-focused interactive booklet to optimise management and medication for childhood fever and infections in out-of-hours primary care: study protocol for a cluster randomised trial

Bont

Dinant

Elshout

et al. 2016

Trials

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BackgroundFever is the most common reason for a child to be taken to a general practitioner (GP), especially during out-of-hours care. It is mostly caused by self-limiting infections. However, antibiotic prescription rates remain high, especially during out-of-hours care. Anxiety and lack of knowledge among parents, and perceived pressure to prescribe antibiotics amongst GPs, are important determinants of excessive antibiotic prescriptions. An illness-focused interactive booklet has the potential to improve this by providing parents with information about fever self-management strategies. The aim of this study is to develop and determine the effectiveness of an interactive booklet on management of children presenting with fever at Dutch GP out-of-hours cooperatives.Methods/designWe are conducting a cluster randomised controlled trial (RCT) with 20 GP out-of-hours cooperatives randomised to 1 of 2 arms: GP access to the illness-focused interactive booklet or care as usual. GPs working at intervention sites will have access to the booklet, which was developed in a multistage process. It consists of a traffic light system for parents on how to respond to fever-related symptoms, as well as information on natural course of infections, benefits and harms of (antibiotic) medications, self-management strategies and ‘safety net’ instructions. Children < 12 years of age with parent-reported or physician-measured fever are eligible for inclusion. The primary outcome is antibiotic prescribing during the initial consultation. Secondary outcomes are (intention to) (re)consult, antibiotic prescriptions during re-consultations, referrals, parental satisfaction and reassurance. In 6 months, 20,000 children will be recruited to find a difference in antibiotic prescribing rates of 25% in the control group and 19% in the intervention group. Statistical analysis will be performed using descriptive statistics and by fitting two-level (GP out-of-hours cooperative and patient) random intercept logistic regression models.DiscussionThis will be the first and largest cluster RCT evaluating the effectiveness of an illness-focused interactive booklet during GP out-of-hours consultations with febrile children receiving antibiotic prescriptions. It is hypothesised that use of the booklet will result in a reduced number of antibiotic prescriptions, improved parental satisfaction and reduced intention to re-consult.Trial registrationClinicalTrials.gov identifier: NCT02594553. Registered on 26 Oct 2015, last updated 15 Sept 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1667-8) contains supplementary material, which is available to authorized users.

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

Cited by 44 publications

References 20 publications

Booklet for Childhood Fever in Out-of-Hours Primary Care: A Cluster-Randomized Controlled Trial

Booklet for Childhood Fever in Out-of-Hours Primary Care: A Cluster-Randomized Controlled Trial

Antibiotic prescribing during office hours and out-of-hours: a comparison of quality and quantity in primary care in the Netherlands

An illness-focused interactive booklet to optimise management and medication for childhood fever and infections in out-of-hours primary care: study protocol for a cluster randomised trial

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