scholarly journals Course of Uncomplicated Acute Gastroenteritis in Children Presenting to Out-of-hours Primary Care

2021 ◽  
Author(s):  
Anouk AH Weghorst ◽  
Irma J Bonvanie ◽  
Gea A Holtman ◽  
Michiel R de Boer ◽  
Marjolein Y Berger
Keyword(s):  
Primary Care ◽  
Acute Gastroenteritis ◽  
Care Service ◽  
Primary Care Service ◽  
Symptom Duration ◽  
Out Of Hours ◽  
Typical Symptom ◽  
Follow Up Study ◽  
Increased Risk

Abstract Background: The aim of this article is to describe the courses of vomiting, diarrhea, fever, and clinical deterioration, in children with uncomplicated gastroenteritis at presentation. This study was performed as a 7-day prospective follow-up study in an out-of-hours primary care service. The course of vomiting, diarrhea, and fever was analyzed by generalized linear mixed modeling. Because young children (≤12 months) and children with severe vomiting are at increased risk of dehydration, the potentially more complicated courses of these groups are described separately. The day(s) most frequently associated with deterioration and the symptoms present in children who deteriorated during follow-up were also described.Results: In total, 359 children presented with uncomplicated acute gastroenteritis to the out-of-hours primary care service. Of these, 31 (8.6%) developed a complicated illness and needed referral or hospitalization. All symptoms decreased within 5 days in most children (>90%). Vomiting and fever decreased rapidly, but diarrhea decreased at a somewhat slower pace, especially among children aged 6–12 months. Children who deteriorated during follow-up had a higher frequency of vomiting at presentation and higher frequencies of vomiting and fever during follow-up.Conclusions: The frequency of vomiting, not its duration, appears to be the more important predictor of deterioration. When advising parents, it is important to explain the typical symptom duration and to focus on alarm symptoms. Clinicians should be vigilant for children with higher vomiting frequencies at presentation and during follow-up because these children are more likely to deteriorate.

Role of out of hours primary care service in limiting inappropriate access to emergency department

2017 ◽  
Vol 13 (4) ◽  
pp. 549-555 ◽  
Author(s):  
Andrea Posocco ◽  
Maria Paola Scapinello ◽  
Irene De Ronch ◽  
Francesco Castrogiovanni ◽  
Gianluca Lollo ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Care Service ◽  
Primary Care Service ◽  
Out Of Hours

scholarly journals Daytime use of general practice and use of the Out-of-Hours Primary Care Service for patients with chronic disease: a cohort study

2014 ◽  
Vol 15 (1) ◽  
Author(s):  
Lone Flarup ◽  
Grete Moth ◽  
Morten Bondo Christensen ◽  
Mogens Vestergaard ◽  
Frede Olesen ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Cohort Study ◽  
Chronic Disease ◽  
Care Service ◽  
Primary Care Service ◽  
Out Of Hours

Psychiatry NCHD referrals to the local emergency department in the context of an in-house primary care service

2020 ◽  
pp. 1-5
Author(s):  
C. Carey ◽  
E. Doody ◽  
R. McCafferty ◽  
M. Madden ◽  
N. Clendennen ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Care Service ◽  
Inpatient Admission ◽  
Primary Care Service ◽  
University Hospital ◽  
Similar Proportion ◽  
Care Services ◽  
Increased Risk ◽  
Local Emergency Department

Objectives. Patients with psychiatric illness are at increased risk of developing non-psychiatric medical illnesses. There have been positive reports regarding the integration of primary care services into mental health facilities. Here, we evaluate the appropriateness of psychiatry non-consultant hospital doctors (NCHD) transfers to the local emergency department (ED) in the context of an in-house primary care service. Methods. We reviewed the inpatient transfers from St Patrick’s University Hospital (SPUH) to the local ED at St James’ Hospital (SJH) from 1 January 2016 to 31 December 2017. We used inpatient admission to SJH as our primary marker of an appropriate transfer. Results. 246 inpatients were transferred from SPUH to the SJH ED for medical review in the years 2016 and 2017. 27 (11%) of these were referred to the ED by the primary care service. 51% of those referred were admitted with similar rates of admission for both general practitioner (n = 27, 54% admitted) and NCHD initiated referrals (n = 219, 51% admitted). Acute neurological illness, concern regarding a cardiac illness, and deliberate self-harm were the most common reasons for referral. Conclusion. Our primary finding is that, of those transferred to ED by either primary care or a psychiatry NCHD, a similar proportion was judged to be in need of inpatient admission. This indicates that as a group, psychiatry NCHD assessment of acuity and need for transfer was similar to that of their colleagues in primary care.

Impact and implementation of Healthy Life Centres, a primary-care service intervention for behaviour change in Norway: Study design

2019 ◽  
Vol 48 (6) ◽  
pp. 594-601 ◽  
Author(s):  
Ellen Eimhjellen Blom ◽  
Line Oldervoll ◽  
Eivind Aadland ◽  
Ane Kristiansen Solbraa ◽  
Guri Kaurstad Skrove
Keyword(s):  
Primary Care ◽  
Data Collection ◽  
Behaviour Change ◽  
Care Service ◽  
Primary Care Service ◽  
Healthy Life ◽  
Service Intervention ◽  
Objectively Measured

Aims: This ongoing study is investigating the implementation and long-term impact of Healthy Life Centres (HLCs), a primary-care service intervention for behaviour change in Norway. The primary aim is to study changes in objectively measured physical activity (PA) levels following a HLC intervention in the short (three months) and long term (15 months). Furthermore, the study is evaluating determinants concerning implementation and adaption of the HLC intervention that influence reach and impact on participants outcomes. Methods: This prospective observational study includes 32 HLCs from four different geographical regions in Norway. Subjects aged ⩾18 years were invited to participate. The study has a pre–post design with a 15-month follow-up. The HLC intervention is a three-month individualised program, containing personal consultations and group-based behaviour-specific courses on PA, diet and smoking cessation. Data collection consists of registration of objectively measured PA level, physical examinations, interviews and questionnaires. In addition, HLC organisation, offers, professions and resources are being examined. The Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework is being applied to study the external validation of the HLC intervention. The study enrolled 1020 participants who gave their written informed consent. Post-tests and follow-up data collection is still ongoing and will continue until August 2019. Conclusions: By exploring the HLC intervention in a real-world setting and addressing the elements of RE-AIM, this study will contribute to an improved understanding and development of effective primary-care behaviour interventions such as the HLC model. The strengths of the study are the large sample size and the many HLCs and regions included.

scholarly journals From Doctor to Nurse Triage in the Danish Out-of-Hours Primary Care Service: Simulated Effects on Costs

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Grete Moth ◽  
Linda Huibers ◽  
Peter Vedsted
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Care Service ◽  
Primary Care Service ◽  
Nurse Training ◽  
Out Of Hours ◽  
Face To Face ◽  
Administrative Costs ◽  
The Cost ◽  
Nurse Triage

Introduction. General practitioners (GP) answer calls to the Danish out-of-hours primary care service (OOH) in Denmark, and this is a subject of discussions about quality and cost-effectiveness. The aim of this study was to estimate changes in fee costs if nurses substituted the GPs. Methods. We applied experiences from The Netherlands on nurse performance in the OOH triage concerning the number of calls per hour. Using the 2011 number of calls in one region, we examined three hypothetical scenarios with nurse triage and calculated the differences in fee costs. Results. A new organisation with 97 employed nurses would be needed. Fewer telephone consultations may result in an increase of face-to-face contacts, resulting in an increase of 23.6% in costs fees. Under optimal circumstances (e.g., a lower demand for OOH services, a high telephone termination rate, and unchanged GP fees) the costs could be reduced by 26.2% though excluding administrative costs of a new organisation. Conclusion. Substituting GPs with nurses in OOH primary care may increase the cost in fees compared to a model with only GPs. Further research is needed involving more influencing factors, such as costs due to nurse training and running the organisation.

scholarly journals Paediatric contacts with the UK out-of-hours primary care service and contact outcomes: a regional service evaluation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
George Edwards ◽  
Rachel Brettell ◽  
Chris Bird ◽  
Helen Hunt ◽  
Dan Lasserson ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Service ◽  
Service Evaluation ◽  
Primary Care Service ◽  
Out Of Hours ◽  
Regional Service ◽  
The Uk
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