title: Which urgent care services do febrile children use and why?
abstract: OBJECTIVE
  To explore how parents navigate urgent and emergency care (U&EC) services when their child <5 years old has a feverish illness, their views of that experience and whether services are meeting their needs and triaging in line with national guidance.
  
  
  METHODS
  Parents of a febrile child <5 years old contacting any U&EC service in three localities during a 6-month period were invited to participate in a telephone questionnaire supplemented by case note review. A subset participated in an in-depth interview.
  
  
  RESULTS
  Of 556 parents expressing an interest, 220 enrolled, making 570 contacts (median 3, range 1-13) with services during the child's illness which lasted 3 days on average. Parents' first preference for advice in hours was to see a general practitioner (GP) (67%; 93/138) and when unavailable, National Health Service Direct (46%; 38/82). 155 made more than one contact and 63% of the repeat contacts were initiated by a service provider. A range of factors influenced parents' use of services. Parents who reported receiving 'safety netting' advice (81%) were less likely to re-present to U&EC services than those who did not recall receiving such advice (35% vs 52%, p=0.01). Parents identified a need for accurate, consistent, written advice regarding fever and antipyretics.
  
  
  CONCLUSIONS
  Parents know the U&EC service options available, and their first choice is the GP. Multiple contacts are being made for relatively well children, often due to repeated referrals within the system. Safety netting advice reduces re-attendances but parents want explicit and consistent advice for appropriate home management.
authors.affiliation: Department of Child Health, Cardiff University School of Medicine, UHW Main Building, Heath Park, Cardiff CF14 4XN, UK. sabinemaguire@yahoo.co.uk
authors.forename: Sabine
authors.initials: S
authors.lastname: Maguire
authors.forename: Rita
authors.initials: R
authors.lastname: Ranmal
authors.forename: Sirkka
authors.initials: S
authors.lastname: Komulainen
authors.forename: Sarah
authors.initials: S
authors.lastname: Pearse
authors.forename: Ian
authors.initials: I
authors.lastname: Maconochie
authors.forename: Monica
authors.initials: M
authors.lastname: Lakhanpaul
authors.forename: Ffion
authors.initials: F
authors.lastname: Davies
authors.forename: Joe
authors.initials: J
authors.lastname: Kai
authors.forename: Terence
authors.initials: T
authors.lastname: Stephenson
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001294:Attitude to Health; D002675:Child, Preschool; D002755:Choice Behavior; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D005194:Family Practice; D005260:Female; D005334:Fever / Q000209:etiology / Q000628:therapy*; D015277:Hotlines / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007255:Information Services / Q000592:standards; D008297:Male; D010290:Parents / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010865:Pilot Projects