Childhood fever: a qualitative study on GPs' experiences during out-of-hours care.
BACKGROUND
Fever in children is common and mostly caused by self-limiting infections. However, parents of febrile children often consult in general practice, in particular during out-of-hours care. To improve management, it is important to understand experiences of GPs managing these consultations.


OBJECTIVE
To describe GPs' experiences regarding management of childhood fever during out-of-hours care.


METHODS
A descriptive qualitative study using purposeful sampling, five focus group discussions were held among 37 GPs. Analysis was based on constant comparative technique using open and axial coding.


RESULTS
Main categories were: (i) Workload and general experience; (ii) GPs' perceptions of determinants of consulting behaviour; (iii) Parents' expectations from the GP's point of view; (iv) Antibiotic prescribing decisions; (v) Uncertainty of GPs versus uncertainty of parents and (vi) Information exchange during the consultation. GPs felt management of childhood fever imposes a considerable workload. They perceived a mismatch between parental concerns and their own impression of illness severity, which combined with time-pressure can lead to frustration. Diagnostic uncertainty is driven by low incidences of serious infections and dealing with parental demand for antibiotics is still challenging.


CONCLUSIONS
Children with a fever account for a high workload during out-of-hours GP care which provides a diagnostic challenge due to the low incidence of serious illnesses and lacking long-term relationship. This can lead to frustration and drives antibiotics prescription rates. Improving information exchange during consultations and in the general public to young parents, could help provide a safety net thereby enhancing self-management, reducing consultations and workload, and subsequent antibiotic prescriptions.
Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, eefje.debont@maastrichtuniversity.nl.
Eefje G P M
EG
de Bont
Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht.
Kirsten K B
KK
Peetoom
Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Faculty of Healthcare, Research Centre for Autonomy and Participation of Chronically Ill People, Centre of Expertise for Technology and Innovative Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands and.
Albine
A
Moser
Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
Nick A
NA
Francis
Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht.
Geert-Jan
GJ
Dinant
Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht.
Jochen W L
JW
Cals
D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000628:therapy; D017144:Focus Groups; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010290:Parents; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012017:Referral and Consultation; D016526:Workload
Antibiotics; child; family practice; infection; primary health care; qualitative research.