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Workload and management of childhood fever at general practice out-of-hours care: an observational cohort study
  1. Eefje G P M de Bont1,
  2. Julie M M Lepot1,
  3. Dagmar A S Hendrix1,
  4. Nicole Loonen1,
  5. Yvonne Guldemond-Hecker2,
  6. Geert-Jan Dinant1,
  7. Jochen W L Cals1
  1. 1Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
  2. 2HOZL Nightcare GP out-of-hours service, Heerlen, The Netherlands
  1. Correspondence to Eefje G P M de Bont; eefje.debont{at}


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.

Design Observational cohort study.

Setting and patients 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.

Main outcome measures 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.


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