title: Adequacy of initial evaluation of fever in long-term care facilities.
abstract: OBJECTIVE
  Febrile residents in long-term care facilities (LTCF) might be inadequately evaluated by caregivers. The present study aimed to examine the factors associated with inadequacy of initial fever evaluations by caregivers at night in LTCF.
  
  
  METHODS
  We carried out a cross-sectional study among a convenience sample of caregivers employed at 11 LTCF in Japan using a vignette-based questionnaire. The respondents were randomly assigned to one of two scenarios describing a mild or severe febrile episode in an LTCF resident at night. The respondents' thinking patterns were classified based on influential factors in their fever evaluation. Associations between adequacy of evaluation and respondents' characteristics were evaluated using generalized linear mixed models.
  
  
  RESULTS
  A total of 34% of fever evaluations among caregivers were considered to be inadequate regarding the necessity for examination by a physician, due in most cases to underestimating the severity of the fever. Respondents' thinking patterns in fever evaluation were significantly associated with the adequacy of the evaluation. Caregivers who placed particular importance on the preferences of residents and families versus other factors including the resident's febrile condition, were more likely to make an inadequate evaluation than those who did not.
  
  
  CONCLUSIONS
  Our findings here suggest that eagerness to comply with residents' preference in fever evaluation could prompt caregivers not to call for an appropriate diagnostic procedure. Geriatr Gerontol Int 2017; 17: 1294-1299.
authors: The Hokkaido Centre for Family Medicine, Hokkaido, Japan.
authors: Kosuke
authors: K
authors: Yamada
authors: The Hokkaido Centre for Family Medicine, Hokkaido, Japan.
authors: Takafumi
authors: T
authors: Nakagawa
authors: The Hokkaido Centre for Family Medicine, Hokkaido, Japan.
authors: Hidenori
authors: H
authors: Hatto
authors: The Hokkaido Centre for Family Medicine, Hokkaido, Japan.|Center for Medical Education, Kyoto University, Kyoto, Japan.
authors: Junichiro
authors: J
authors: Miyachi
authors: Department of Family Medicine, Mie University School of Medicine, Mie, Japan.
authors: Masato
authors: M
authors: Narushima
authors: Department of Neurology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan.
authors: Ken
authors: K
authors: Sakushima
authors: Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.|Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan.|Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan.
authors: Shingo
authors: S
authors: Fukuma
authors: Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.|Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan.
authors: Yukari
authors: Y
authors: Yamada
authors: Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.|Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan.|Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan.
authors: Shunichi
authors: S
authors: Fukuhara
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005334:Fever / Q000175:diagnosis*; D015577:Geriatric Assessment; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007564:Japan; D008134:Long-Term Care; D008297:Male; D009733:Nursing Diagnosis; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: caregiver; decision-making; fever; long-term care; referral and consultation