Abstract
OBJECTIVE--To identify reasons why some children receive more out of hours visits than most. DESIGN--A one year prospective study to identify the study group. This was followed by a case-control study involving a record search and personal interviews. SETTING--One three doctor urban general practice in West Lothian with 4812 patients. SUBJECTS--40 children aged under 10 years identified as high users of the out of hours service (more than two visits a year) and 40 age and sex matched controls. MAIN OUTCOME MEASURES--Numbers of visits; social factors such as lone motherhood, low educational attainment; score for management response to clinical vignette. RESULTS--147/756 (19%) out of hours visits in the study year were to children aged under 10 years; 109 (74%) to 41 children (6%). Problems seen were mainly minor, and little active management was required. Family and social factors which were significantly more common for the cases than for the controls included a lone mother (15 v 4), low educational attainment by the mother (25 v 14), receipt of income support (22 v 7), and non-ownership of the home (45 v 22) or a car (19 v 9). Mothers of the cases were more likely to choose to contact a doctor when presented with vignettes describing common childhood illnesses (median score for 16 vignettes 16.5 for cases v 14.5 for controls, Wilcoxon signed rank test, p = 0.01). CONCLUSIONS--Children seen more frequently than expected out of hours came from more socially disadvantaged families and their mothers were more likely to seek medical advice about minor childhood illness. Maternal education, to promote confidence in managing minor illness, may reduce their use of the out of hours service.
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- Bhopal J. S., Bhopal R. S. Perceived versus actual consultation patterns in an inner city practice. J R Coll Gen Pract. 1989 Apr;39(321):156–157. [PMC free article] [PubMed] [Google Scholar]
- Bollam M. J., McCarthy M., Modell M. Patient's assessment of out of hours care in general practice. Br Med J (Clin Res Ed) 1988 Mar 19;296(6625):829–832. doi: 10.1136/bmj.296.6625.829. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Campion P. D., Gabriel J. Illness behaviour in mothers with young children. Soc Sci Med. 1985;20(4):325–330. doi: 10.1016/0277-9536(85)90005-x. [DOI] [PubMed] [Google Scholar]
- Duncan J. K., Taylor R. J., Fordyce I. D. Factors associated with variation in the consultation rates of children aged under five years. J R Coll Gen Pract. 1987 Jun;37(299):251–254. [PMC free article] [PubMed] [Google Scholar]
- Pitts J., Whitby M. Out of hours workload of a suburban general practice: deprivation or expectation. BMJ. 1990 Apr 28;300(6732):1113–1115. doi: 10.1136/bmj.300.6732.1113. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tulloch A. J. 'Out of hours' calls in an Oxfordshire practice. Practitioner. 1984 Jul;228(1393):663–666. [PubMed] [Google Scholar]
- Usherwood T. P. Development and randomized controlled trial of a booklet of advice for parents. Br J Gen Pract. 1991 Feb;41(343):58–62. [PMC free article] [PubMed] [Google Scholar]
- WAYNE E. J. Clinical and metabolic studies in thyroid disease. Br Med J. 1960 Jan 2;1(5165):1–11. doi: 10.1136/bmj.1.5165.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Walker R. D. Study of out-of-hours visits to children. J R Coll Gen Pract. 1985 Sep;35(278):427–428. [PMC free article] [PubMed] [Google Scholar]
- Westhead J. N. Frequent attenders in general practice: medical, psychological and social characteristics. J R Coll Gen Pract. 1985 Jul;35(276):337–340. [PMC free article] [PubMed] [Google Scholar]
- Williams D. J. Patients' assessment of out of hours care. Br Med J (Clin Res Ed) 1988 Apr 23;296(6630):1197–1197. doi: 10.1136/bmj.296.6630.1197. [DOI] [PMC free article] [PubMed] [Google Scholar]
- de Dombal F. T., Leaper D. J., Staniland J. R., McCann A. P., Horrocks J. C. Computer-aided diagnosis of acute abdominal pain. Br Med J. 1972 Apr 1;2(5804):9–13. doi: 10.1136/bmj.2.5804.9. [DOI] [PMC free article] [PubMed] [Google Scholar]