title: Workload and management of childhood fever at general practice out-of-hours care: an observational cohort study.
abstract: OBJECTIVE
  Even though childhood fever is mostly self-limiting, children with fever constitute a considerable workload in primary care. Little is known about the number of contacts and management during general practitioners' (GPs) out-of-hours care. We investigated all fever related telephone contacts, consultations, antibiotic prescriptions and paediatric referrals of children during GP out-of-hours care within 1 year.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  We performed an observational cohort study at a large Dutch GP out-of-hours service. Children (<12 years) whose parents contacted the GP out-of-hours service for a fever related illness in 2012 were included.
  
  
  METHODS
  Number of contacts and consultations, antibiotic prescription rates and paediatric referral rates.
  
  
  RESULTS
  We observed an average of 14.6 fever related contacts for children per day at GP out-of-hours services, with peaks during winter months. Of 17,170 contacts in 2012, 5343 (31.1%) were fever related and 70.0% resulted in a GP consultation. One in four consultations resulted in an antibiotic prescription. Prescriptions increased by age and referrals to secondary care decreased by age (p<0.001). The majority of parents (89.5%) contacted the out-of-hours service only once during a fever episode (89.5%) and 7.6% of children were referred to secondary care.
  
  
  CONCLUSIONS
  This study shows that childhood fever does account for a large workload at GP out-of-hours services. One in three contacts is fever related and 70% of those febrile children are called in to be assessed by a GP. One in four consultations for childhood fever results in antibiotic prescribing and most consultations are managed in primary care without referral.
authors.affiliation: Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Eefje G P M
authors.initials: EG
authors.lastname: de Bont
authors.affiliation: Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Julie M M
authors.initials: JM
authors.lastname: Lepot
authors.affiliation: Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Dagmar A S
authors.initials: DA
authors.lastname: Hendrix
authors.affiliation: Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Nicole
authors.initials: N
authors.lastname: Loonen
authors.affiliation: HOZL Nightcare GP out-of-hours service, Heerlen, The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Guldemond-Hecker
authors.affiliation: Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Dinant
authors.affiliation: Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jochen W L
authors.initials: JW
authors.lastname: Cals
mesh_terms: D039602:After-Hours Care / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005334:Fever / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D058006:General Practice; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019114:Remote Consultation; D012720:Severity of Illness Index; D016526:Workload
chemical_list: D000900:Anti-Bacterial Agents
keywords: PRIMARY CARE; PUBLIC HEALTH