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Mollet A, Rousselet L, Tristram D, Kalach N, Pelzer MM, Charkaluk ML, Delebarre M. Comparison between local and three validated triage systems in an emergency department for 2126 children under 3 months. Acta Paediatr 2023; 112:1986-1994. [PMID: 37222311 DOI: 10.1111/apa.16858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 05/25/2023]
Abstract
AIM Triage of patients less than 3 months old was not already studied. The aim was to evaluate Paediatric Emergency Department triage in patients less than 3 months old and newborns using a local system in comparison with three validated paediatric triage systems (Canadian Triage and Acuity Scale, Manchester Triage System and Emergency Severity Index) and to determine inter-system agreement. METHODS All admissions of patients less than 3 months old admitted to the Emergency Department of the Saint Vincent University Hospital between April 2018 and December 2019 were included. The local triage system level was determined prospectively for comparison with retrospectively calculated triage levels of the validated systems. Hospitalisation rates were compared and inter-system agreements determined. RESULTS Among emergency admissions, 2126 were included (55% males, mean age 45 days). Hospitalisation rate increased with priority severity as determined by all triage systems studied. Cohen's kappa showed slight agreement between the local triage system and the Canadian Triage and Acuity Scale, Emergency Severity Index and Manchester Triage System (weighted kappa = 0.133, 0.185 and 0.157 respectively). CONCLUSION Whether prospective or retrospective triage used, the systems studied exhibited good association with hospitalisation rate for patients aged less than 3 months and newborn infants.
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Affiliation(s)
- Agathe Mollet
- Lille Catholic hospitals, Paediatric Department, Lille Catholic University, Lille, France
| | - Louis Rousselet
- Lille Catholic hospitals, Medical Information Department, Lille Catholic University, Lille, France
| | - Domitille Tristram
- Lille Catholic hospitals, Research Department, Lille Catholic University, Lille, France
| | - Nicolas Kalach
- Lille Catholic hospitals, Paediatric Department, Lille Catholic University, Lille, France
| | - Marie Moukagni Pelzer
- Lille Catholic hospitals, Paediatric Department, Lille Catholic University, Lille, France
| | - Marie-Laure Charkaluk
- Lille Catholic hospitals, Neonatology Department, Lille Catholic University, Lille, France
| | - Mathilde Delebarre
- Lille Catholic hospitals, Paediatric Department, Lille Catholic University, Lille, France
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Tischler L, Beyer A, Moon K, Hoffmann W, van den Berg N. Effects of Closure of the Paediatric Department of a District Hospital on Regional Care: Analysis of Patient Flows. DAS GESUNDHEITSWESEN 2023; 85:S205-S211. [PMID: 37751757 PMCID: PMC10662054 DOI: 10.1055/a-2130-2479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND The consequences of economization and staff shortage in the German health care system strongly affect paediatric care structures, especially in rural regions. It is not known how closures of paediatric departments influence patient flows of surrounding hospitals. Here, we investigate the quantitative effects of closure of the paediatric department of a district hospital and the subsequent opening of an alternative inpatient service on the utilisation of inpatient and outpatient care services of the two neighboring hospitals and the emergency services of the region. METHODOLOGY In the observation period from 2015 to 2019, patient-related data from the three hospitals in the study region as well as data from the rescue service were evaluated. RESULTS In the year after the paediatric department of the district hospital was closed in 2016, the total number of inpatient cases in the region decreased by 33% (2015: n=1,787; 2016: n=1,193) and then decreased by an additional 11% (2019: n=1,005). The number of outpatient cases decreased by further 8% (2015: n=6,250; 2019: n=5,770). In the last observation year, emergency services were used much more frequently than in the year before the closure (2015: n=398; 2019: n=572). This means an increase of 44%. CONCLUSION After the closure of the paediatric department, the total number of inpatient cases in the region fell sharply. However, actual gaps in care apparently did not arise. Before closing, the consequences for the surrounding hospitals should be assessed more precisely. Real gaps in care must be counteracted, e. g. through alternative outpatient services.
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Affiliation(s)
- Luisa Tischler
- Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin
Greifswald Institut für Community Medicine, Greifswald, Germany
| | - Angelika Beyer
- Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin
Greifswald Institut für Community Medicine, Greifswald, Germany
| | - Kilson Moon
- Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin
Greifswald Institut für Community Medicine, Greifswald, Germany
| | - Wolfgang Hoffmann
- Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin
Greifswald Institut für Community Medicine, Greifswald, Germany
| | - Neeltje van den Berg
- Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin
Greifswald Institut für Community Medicine, Greifswald, Germany
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Visscher S, van Stralen K, Toelen J, de Winter P. Parental and physician disagreement on help-seeking in paediatric case scenarios. Arch Dis Child 2022; 107:833-838. [PMID: 35351739 DOI: 10.1136/archdischild-2021-323504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/04/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Whenever a child falls ill, parents need to decide whether there is a need to contact medical professionals. Parental and physician perspectives on the severity of a child's illness differ. We aimed to determine triggers for help-seeking among parents. DESIGN AND SETTING We conducted a survey study among 200 parents. In four hypothetical case scenarios, an acutely ill child was described with a baseline symptom (abdominal pain, rhinitis, headache, limping), with deterioration over time. Parents had to answer when they would contact the general practitioner. Fifty-four physicians received the same case scenarios. MAIN OUTCOME MEASURES Parents and physicians did not differ significantly in help-seeking in the abdominal pain case. In the non-urgent rhinitis case, parents sought help earlier than physicians wished them to, while in the urgent illness cases of headache and limping parents tend to seek help later than physicians wished. Rising body temperature was more alarming to parents than physicians, while loss of appetite did not concern either group. Parents did not recognise several red flags, for example, drowsiness and refusal to stand. Low educated parents and parents with a history of more frequent healthcare use were inclined to seek help earlier. IMPLICATION OF RESULTS In urgent cases, parents do not seem to recognise red flags, while some non-urgent symptoms trigger them to seek help. This reveals a need for mutual education. Physician awareness of a perception gap could help them adjust their communication and empower parents.
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Affiliation(s)
- Sarah Visscher
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands
| | - Karlijn van Stralen
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands
| | - Jaan Toelen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Leuven Child and Youth Institute, KU Leuven, Leuven, Belgium.,Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Peter de Winter
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands .,Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Leuven Child and Youth Institute, KU Leuven, Leuven, Belgium
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Dal Negro RW, Zanasi A, Turco P, Povero M. Acute cough in Italian children: parents' beliefs, approach to treatment, and the family impact. Multidiscip Respir Med 2019; 14:16. [PMID: 30988950 PMCID: PMC6448239 DOI: 10.1186/s40248-019-0180-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute cough is the most common symptom among children in primary care, but the impact of cough episodes was never investigated in Italian families. METHODS A cross-sectional telephone survey was conducted on a representative sample of Italian families, randomly selected from general population; a specific and validated questionnaire was used. RESULTS The sample (604 calls) was uniform by geographical distribution, and by children age and gender. Mean cough episode was 3.1/year, they were short lasting (only 4.7% > 2 weeks). Independent predictors of children cough episodes were parents' active smoking habit and work (p < 0.05). The mean nursery/school absenteeism was mostly < 7 days, but of a 7-15-day duration in near 30% of cases. The pediatrician was contacted immediately only by 25% of parents and a second consultation (mostly a lung physician) usually occurred after 2-3 weeks of cough. Meanwhile, home/pharmacist suggested remedies were adopted in 50-70% of cases. Usual prescriptions were mucolytics (85.8%), antitussive agents (55.6%), non-steroideal anti-inflammatory drugs (33.8%), antibiotics (regularly or episodically 80%), and corticosteroids (systemic steroids in less than 50%, but via aerosol in more than 80% of cases). Moreover, pediatricians claimed to use homeopathic drugs regularly or episodically in almost 50%. The respondents' willingness to spend out-of-pocket for an "effective remedy" against cough was of € 20 (>€ 30 in 18.4% of cases). CONCLUSIONS Parents' actions against cough episodes were variable, depending on their beliefs, smoking habit, and occupational status. The parents' perceived efficacy of usual prescriptions is poor, and their willingness to pay out-of-pocket for an "effective remedy" against cough is high. The interest for alternative treatments is not negligible in these circumstances.
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Affiliation(s)
- Roberto W. Dal Negro
- National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology, Verona, Italy
| | | | - Paola Turco
- Research & Clinical Governance, Verona, Italy
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Lass M, Tatari CR, Merrild CH, Huibers L, Maindal HT. Contact to the out-of-hours service among Danish parents of small children - a qualitative interview study. Scand J Prim Health Care 2018; 36:216-223. [PMID: 29633663 PMCID: PMC6066288 DOI: 10.1080/02813432.2018.1459431] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE In Denmark, parents with small children have the highest contact frequency to out-of-hours (OOH) service, but reasons for OOH care use are sparsely investigated. The aim was to explore parental contact pattern to OOH services and to explore parents' experiences with managing their children's acute health problems. DESIGN A qualitative study was undertaken drawing on a phenomenological approach. We used semi-structured interviews, followed by an inductive content analysis. Nine parents with children below four years of age were recruited from a child day care centre in Aarhus, Denmark for interviews. RESULTS Navigation, information, parental worry and parental development appeared to have an impact on OOH services use. The parents found it easy to navigate in the health care system, but they often used the OOH service instead of their own general practitioner (GP) due to more compatible opening hours and insecurity about the urgency of symptoms. When worried about the severity, the parents sought information from e.g. the internet or the health care professionals. The first child caused more worries and insecurity due to less experience with childhood diseases and the contact frequency seemed to decrease with parental development. CONCLUSION Parents' use of the OOH service is affected by their health literacy levels, e.g. level of information, how easy they find access to their GP, how trustworthy and authorized health information is, as well as how much they worry and their parental experience. These findings must be considered when planning effective health services for young families. Key points The main findings are that the parents in our study found it easy to navigate in the healthcare system, but they used the OOH service instead of their own general practitioner, when this suited their needs. The parents sought information from e.g. the internet or the health care professionals when they were worried about the severity of their children's diseases. They sometimes navigated strategically in the healthcare system by e.g. using the OOH service for reassurance and when it was most convenient according to opening hours. The first child seemed to cause more worries and insecurity due to limited experience with childhood diseases, and parental development seems to decrease contact frequency. Overall, this study contributes with valuable insights into the understanding of parents' help seeking behaviour. There seems to be a potential for supporting especially first-time parents in their use of the out of hours services.
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Affiliation(s)
- Marie Lass
- Department of Public Health, Aarhus University, Aarhus, Denmark;
- CONTACT Ms M. Lass Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Camilla Hoffmann Merrild
- Department of Public Health, Research Unit for General Practice & Section for General Medicine Practice, Aarhus University, Aarhus, Denmark;
| | - Linda Huibers
- Department of Public Health, Research Unit for General Practice & Section for General Medicine Practice, Aarhus University, Aarhus, Denmark;
| | - Helle Terkildsen Maindal
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Aarhus, Denmark;
- Steno Diabetes Center Copenhagen, Health Promotion Research, Gentofte, Denmark
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Moth G, Huibers L, Ovesen A, Christensen MB, Vedsted P. Preschool children in out-of-hours primary care - a questionnaire-based cross-sectional study of factors related to the medical relevance of health problems. BMC FAMILY PRACTICE 2017; 18:112. [PMID: 29281986 PMCID: PMC5746005 DOI: 10.1186/s12875-017-0702-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/18/2017] [Indexed: 11/15/2022]
Abstract
Background Out-of-hours primary care (OOH-PC) is intended to provide medical care services for health problems that cannot wait until normal office hours. Children under five years of age represent about 19% of all OOH-PC contacts in Denmark, and the frequency of calls assessed as severe by health professionals is markedly lower for children than for other age groups. Several studies have questioned the appropriateness of the parents’ use of OOH-PC. We aimed to identify factors associated with calls from parents of pre-school children concerning perceived non-severe health problems that were ranked by the triaging GPs as more appropriate for GP office hours (defined as ‘medically irrelevant’). Methods We used data from a cross-sectional study performed in the Central Denmark Region for a 1-year period during 2010–2011. GPs in the OOH-PC assessed random contacts, and a questionnaire was subsequently sent to registered patients. Associations between different factors and the medical irrelevance of contacts were estimated with a generalised linear model to calculate the prevalence ratio (PR). Results Among all included 522 telephone consultations and 1226 face-to-face consultations, we identified 71 (13.6%) telephone consultations and 95 (7.8%) face-to-face consultations that were both assessed as non-severe by the parents and more appropriate for GP office hours by the GPs. For telephone consultations, contacts at other times than 4–8 pm on weekdays were statistically significantly associated with medical irrelevance. Additionally, symptoms of longer duration than 24 h were statistically significantly associated medical irrelevance. Conclusions A large part of the calls to the Danish OOH-PC concern children. The results indicate that some of these calls are made for other than strictly medical reasons. To achieve more effective use of available resources, it might seem relevant to aim at directing more contacts directly to daytime care. However, future studies to enhance our knowledge on parents’ motivation and behaviour would be recommendable.
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Affiliation(s)
- Grete Moth
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark. .,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.
| | - Linda Huibers
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Astrid Ovesen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
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Kesten JM, Anderson EC, Lane I, Hay AD, Cabral C. Parent views on the content and potential impact of respiratory tract infection surveillance information: semistructured interviews to inform future research. BMJ Paediatr Open 2017; 1:e000036. [PMID: 29637100 PMCID: PMC5843006 DOI: 10.1136/bmjpo-2017-000036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/26/2017] [Accepted: 07/20/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study explored the potential value of real-time information regarding respiratory tract infections (RTIs) circulating in the community by eliciting parent views on illustrative surveillance information and its possible impact on primary care consultations. DESIGN Semistructured interviews were conducted with parents of children (>3 months-15 years). Participants were presented with example information on circulating viruses, symptoms and symptom duration and asked about its potential impact on perceptions of child illness and management practices. Interviews were analysed using the framework method. SETTING Parents participating in a cohort study were selected purposefully using index of multiple deprivation and child age. PARTICIPANTS 30 mothers of children (>3 months-15years). RESULTS Parents anticipated using the information to inform lay diagnoses particularly when child symptoms were severe and thought normal symptom duration awareness might extend the time prior to seeking medical advice, but it also may encourage consultations when symptoms exceed the given duration. The information was not expected to change consultation behaviour if parents felt their child needed a medical evaluation and they felt unable to manage the symptoms. Most parents felt that the information could provide reassurance that could reduce intention to consult, but some felt it could raise concerns, by heightening awareness of circulating viruses. Lastly, parents wanted advice about protecting children from circulating viruses and felt that general practitioners using the information to diagnose child RTIs with greater certainty was acceptable. CONCLUSIONS Diverse responses to the surveillance information were elicited, and there was some support for the intended outcomes. This study has important implications for the design of interventions to modify consulting behaviour. Future piloting to measure behaviour change in response to infection surveillance information are needed.
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Affiliation(s)
- Joanna May Kesten
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, School of Social and Community Medicine, University of Bristol, Bristol, UK.,The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Emma C Anderson
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, School of Social and Community Medicine, University of Bristol, Bristol, UK.,Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Isabel Lane
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.,NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alastair D Hay
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, School of Social and Community Medicine, University of Bristol, Bristol, UK.,Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Christie Cabral
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Ertmann R, Siersma V, Reventlow S, Söderström M. Health care experiences in infancy and subsequent frequent illness in 1-year-old children. Health (London) 2013. [DOI: 10.4236/health.2013.52035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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